Provider Demographics
NPI:1245960756
Name:PALM COAST PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PALM COAST PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFINITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-265-5555
Mailing Address - Street 1:3 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5605
Mailing Address - Country:US
Mailing Address - Phone:908-265-5555
Mailing Address - Fax:
Practice Address - Street 1:154 STATE ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:908-265-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy