Organization
COASTAL ORTHOPEDIC CENTER, INC
Active
Other names
coastal limbs & brace
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH PERRETTA C.P. (OWNER)
(772) 871-9200
Entity
Organization
Contact information
Practice address
510 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-1943
(772) 871-9200
(772) 336-4040
Mailing address
510 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-1943
(772) 871-9200
(772) 336-4040
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PRO84
FL
Other
Enumeration date
12/11/2007
Last updated
12/19/2007
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