Provider Demographics
NPI:1780293837
Name:COASTAL MOVEMENT SPECIALISTS LLC
Entity type:Organization
Organization Name:COASTAL MOVEMENT SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:317-752-4580
Mailing Address - Street 1:2052 RIVER RD STE E
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-9043
Mailing Address - Country:US
Mailing Address - Phone:843-900-6202
Mailing Address - Fax:
Practice Address - Street 1:2052 RIVER RD STE E
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-8805
Practice Address - Country:US
Practice Address - Phone:843-900-6202
Practice Address - Fax:843-574-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy