Provider Demographics
NPI:1689026676
Name:KNEE COASTER, LLC
Entity Type:Organization
Organization Name:KNEE COASTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-798-7817
Mailing Address - Street 1:835 E LAMAR BLVD
Mailing Address - Street 2:STE 388
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011
Mailing Address - Country:US
Mailing Address - Phone:817-798-7817
Mailing Address - Fax:844-734-2233
Practice Address - Street 1:1675 SOTOGRANDE BLVD
Practice Address - Street 2:202
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053
Practice Address - Country:US
Practice Address - Phone:817-798-7817
Practice Address - Fax:844-734-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies