Organization
COASTAL PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY POULOS (OWNER)
(910) 799-4199
Entity
Organization
Contact information
Practice address
3114 RANDALL PKWY STE 2, WILMINGTON, NC 28403-2590
(910) 799-4199
Mailing address
3114 RANDALL PKWY STE 2, WILMINGTON, NC 28403-2590
(910) 799-4199
(910) 799-1616
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0238Q
BLUE CROSS BLUE SHIELD
NC
05
—
7210529
—
NC
Enumeration date
02/21/2006
Last updated
04/20/2008
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