Provider Demographics
NPI:1952485765
Name:COASTAL ORTHOPEDICS & SPORTS MEDICINE,P.A.
Entity Type:Organization
Organization Name:COASTAL ORTHOPEDICS & SPORTS MEDICINE,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHILIPPA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-442-0325
Mailing Address - Street 1:PO BOX 5544
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5500
Mailing Address - Country:US
Mailing Address - Phone:207-442-0325
Mailing Address - Fax:207-442-0355
Practice Address - Street 1:14 THOMAS POINT RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3911
Practice Address - Country:US
Practice Address - Phone:207-442-0325
Practice Address - Fax:207-443-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9324Medicare PIN