Organization
COASTAL PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA RACHEL MARTIN MSPT (PRESIDENT)
19416810278
Entity
Organization
Contact information
Practice address
18990 PERSIMMON RIDGE RD, ALVA, FL 33920-3367
(941) 681-0278
(239) 236-0217
Mailing address
PO BOX 62095, FORT MYERS, FL 33906-2095
(941) 681-0278
(239) 236-0217
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT23483
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920922584420-002
CCN
FL
01
—
AN9692Z
MEDICARE NUMBER
FL
01
—
CM700A
PTAN
FL
Enumeration date
05/20/2009
Last updated
09/16/2010
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