# COAST SPINE AND SPORTS MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coast Injury Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790401016
- **Authorized official:** SANDY CLEMENS (ACCESS MANAGER)
- **Authorized official phone:** (536) 481-8532

## Contact information

- **Practice address:** 8140 FREEDOM LN NE STE A, LACEY, WA 98516-4752
- **Practice address phone:** (253) 648-1853
- **Practice address fax:** (425) 800-9756
- **Mailing address:** 8012 112TH STREET CT E STE 120, PUYALLUP, WA 98373-7856
- **Mailing address phone:** (253) 648-1853
- **Mailing address fax:** (425) 800-9756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/18/2022
- **Last updated:** 07/05/2024