# COAST PAIN RELIEF CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033357694
- **Authorized official:** MS. LINDSAY NICOLE PETTY (OFFICE MANAGER)
- **Authorized official phone:** (772) 873-5552

## Contact information

- **Practice address:** 3233 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-3490
- **Practice address phone:** (772) 873-5552
- **Practice address fax:** (772) 873-5747
- **Mailing address:** 3233 SW PORT ST. LUCIE BLVD, PORT ST. LUCIE, FL 34953-3490
- **Mailing address phone:** (772) 873-5552
- **Mailing address fax:** (772) 873-5747

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | ME 62002 | FL | Yes |

## Other

- **Enumeration date:** 02/04/2009
- **Last updated:** 02/04/2009