Provider Demographics
| NPI: | 1780141572 |
|---|---|
| Name: | EMERALD COAST PHYSICAL THERAPY LLC |
| Entity type: | Organization |
| Organization Name: | EMERALD COAST PHYSICAL THERAPY LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF OPERATIONS |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BRETT |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MCKINNEY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 850-714-6166 |
| Mailing Address - Street 1: | 35008 EMERALD COAST PKWY STE 400 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DESTIN |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 32541-4753 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 850-714-6166 |
| Mailing Address - Fax: | 850-714-6167 |
| Practice Address - Street 1: | 35008 EMERALD COAST PKWY STE 400 |
| Practice Address - Street 2: | |
| Practice Address - City: | DESTIN |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 32541-4753 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 850-714-6166 |
| Practice Address - Fax: | 850-714-6166 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-02-27 |
| Last Update Date: | 2023-02-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Multi-Specialty |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
