Organization
COASTAL THERAPEUTICS AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONCEPTION P GONZALES LMT (OWNER)
(808) 600-1771
Entity
Organization
Contact information
Practice address
9573 SHORE DR STE F, NORFOLK, VA 23518-1722
(808) 600-1771
Mailing address
3807 FLOWERFIELD RD APT A, NORFOLK, VA 23518-4700
(808) 600-1771
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
111NR0400X
Rehabilitation Chiropractor
—
—
225700000X
Massage Therapist
—
—
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
08/16/2023
Last updated
08/16/2023
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