Provider Demographics
NPI:1023528841
Name:COASTAL CARE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:COASTAL CARE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIRAO
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARYCYST
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:302-524-8333
Mailing Address - Street 1:37197 E STONEY RUN
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-4325
Mailing Address - Country:US
Mailing Address - Phone:302-524-8333
Mailing Address - Fax:
Practice Address - Street 1:6 ELLIS ALLEY
Practice Address - Street 2:UNIT 6
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975
Practice Address - Country:US
Practice Address - Phone:302-524-8333
Practice Address - Fax:302-524-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty