Provider Demographics
NPI:1295169258
Name:COASTAL PHYSICAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:COASTAL PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:267-374-9785
Mailing Address - Street 1:906 S FEDERAL HWY STE B
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5671
Mailing Address - Country:US
Mailing Address - Phone:561-738-0805
Mailing Address - Fax:561-738-0815
Practice Address - Street 1:906 S FEDERAL HWY STE B
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-5671
Practice Address - Country:US
Practice Address - Phone:561-738-0805
Practice Address - Fax:561-738-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty