Provider Demographics
NPI:1649594896
Name:COASTAL THERAPY GROUP
Entity Type:Organization
Organization Name:COASTAL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MASTROMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-370-0317
Mailing Address - Street 1:16818 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3218
Mailing Address - Country:US
Mailing Address - Phone:310-370-0317
Mailing Address - Fax:310-542-0800
Practice Address - Street 1:16818 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3218
Practice Address - Country:US
Practice Address - Phone:310-370-0317
Practice Address - Fax:310-542-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty