Provider Demographics
NPI:1629082698
Name:EMERALD COAST THERAPY CENTERS, INC.
Entity Type:Organization
Organization Name:EMERALD COAST THERAPY CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PADGET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-473-9707
Mailing Address - Street 1:2411 EXECUTIVE PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8269
Mailing Address - Country:US
Mailing Address - Phone:850-473-9707
Mailing Address - Fax:850-476-9519
Practice Address - Street 1:2411 EXECUTIVE PLAZA RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8269
Practice Address - Country:US
Practice Address - Phone:850-473-9707
Practice Address - Fax:850-476-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684852Medicare ID - Type Unspecified