Provider Demographics
NPI:1740328368
Name:COASTAL HAND THERAPY AND REHABILITATION INC
Entity type:Organization
Organization Name:COASTAL HAND THERAPY AND REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FRIEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CHT
Authorized Official - Phone:904-318-8818
Mailing Address - Street 1:3724 CATHEDRAL OAKS PL N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4210
Mailing Address - Country:US
Mailing Address - Phone:904-318-8818
Mailing Address - Fax:904-737-9850
Practice Address - Street 1:14546 SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5468
Practice Address - Country:US
Practice Address - Phone:904-318-8818
Practice Address - Fax:904-737-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4237174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9586Medicare PIN