# COAST SPINE AND SPORTS MEDICINE

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

## Provider details

- **NPI number:** 1831972793
- **Authorized official:** SANDY CLEMENS (BILLING MANAGER)
- **Authorized official phone:** (253) 648-1853

## Contact information

- **Practice address:** 2727 HOLLYCROFT ST STE 290, GIG HARBOR, WA 98335-1305
- **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 |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/15/2023
- **Last updated:** 07/05/2024