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Organization
INTRACOASTAL PHYSICAL THERAPY, LLC
Active
Organization
INTRACOASTAL PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW KARL THOMPSON RPT (OWNER)
(321) 951-2416
Entity
Organization
Contact information
Practice address
308 S HARBOR CITY BLVD, SUITE B, MELBOURNE, FL 32901-1500
(321) 951-2416
(321) 951-2077
Mailing address
308 S HARBOR CITY BLVD, SUITE B, MELBOURNE, FL 32901-1500
(321) 951-2416
(321) 951-2077
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y902W
BLUE CROSS/BLUE SHIELD GR
FL
Enumeration date
11/11/2005
Last updated
08/22/2020
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