Organization
COASTAL PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL TAVERAS (OWNER)
(631) 654-2225
Entity
Organization
Contact information
Practice address
38 OAK ST STE 2, PATCHOGUE, NY 11772-2883
(631) 654-2225
Mailing address
38 OAK ST STE 2, PATCHOGUE, NY 11772-2883
(631) 654-2225
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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