Provider Demographics
NPI: | 1942361522 |
---|---|
Name: | COASTAL ORTHOPEDICS AND SPORTS MEDICINE OF SOUTHWEST FLORIDA P.A. |
Entity Type: | Organization |
Organization Name: | COASTAL ORTHOPEDICS AND SPORTS MEDICINE OF SOUTHWEST FLORIDA P.A. |
Other - Org Name: | COASTAL PHYSICAL THERAPY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CREDENTIALING SURPERVISOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NANCY |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | BORGGREN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 941-782-0102 |
Mailing Address - Street 1: | 6015 POINTE WEST BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | BRADENTON |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34209-5532 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 941-782-2000 |
Mailing Address - Fax: | 941-794-1863 |
Practice Address - Street 1: | 6015 POINTE WEST BLVD |
Practice Address - Street 2: | |
Practice Address - City: | BRADENTON |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34209-5532 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-782-2000 |
Practice Address - Fax: | 941-794-1863 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-12-13 |
Last Update Date: | 2022-02-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | Group - Multi-Specialty | |
No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Multi-Specialty |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |