Provider Demographics
NPI:1881420917
Name:COASTAL REHABILITATION LLC
Entity type:Organization
Organization Name:COASTAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-248-2468
Mailing Address - Street 1:7113 LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-5509
Mailing Address - Country:US
Mailing Address - Phone:850-257-6464
Mailing Address - Fax:850-248-2469
Practice Address - Street 1:229 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4905
Practice Address - Country:US
Practice Address - Phone:850-481-1117
Practice Address - Fax:850-373-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty