Provider Demographics
NPI:1356949317
Name:COAST PHYSIO LLC
Entity type:Organization
Organization Name:COAST PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-604-0626
Mailing Address - Street 1:140 METEDECONK RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5442
Mailing Address - Country:US
Mailing Address - Phone:732-604-0626
Mailing Address - Fax:732-929-7407
Practice Address - Street 1:140 METEDECONK RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-5442
Practice Address - Country:US
Practice Address - Phone:646-321-9579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy