Provider Demographics
NPI:1659687267
Name:COASTAL PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:COASTAL PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:BEAL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:207-483-4022
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04643-0220
Mailing Address - Country:US
Mailing Address - Phone:207-483-4022
Mailing Address - Fax:207-483-9722
Practice Address - Street 1:1110 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643
Practice Address - Country:US
Practice Address - Phone:207-271-7302
Practice Address - Fax:207-483-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2403261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508823345OtherINDIVIDUAL NPI
ME249640099Medicaid