Provider Demographics
NPI:1740563402
Name:COAST PHYSICAL THERAPY & COAST REHAB
Entity Type:Organization
Organization Name:COAST PHYSICAL THERAPY & COAST REHAB
Other - Org Name:PATRIOT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BONZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-732-0036
Mailing Address - Street 1:28901 S WESTERN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0001
Mailing Address - Country:US
Mailing Address - Phone:310-732-0036
Mailing Address - Fax:310-732-0250
Practice Address - Street 1:28901 S WESTERN AVE STE 103
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0001
Practice Address - Country:US
Practice Address - Phone:310-732-0036
Practice Address - Fax:310-732-0250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRIOT PHYSICAL THERAPY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty