Organization
COASTLINE IMAGING LLC
Active
Organization
COASTLINE IMAGING LLC
Active
Other names
Coastline Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DANETTE MICHELLE LAURICIA (CREDENTIALING MANAGER)
(321) 253-2700
Entity
Organization
Contact information
Practice address
1341 MEDICAL PARK DR, STE. 202, MELBOURNE, FL 32901-3235
(321) 253-2700
Mailing address
1341 MEDICAL PARK DR, STE. 202, MELBOURNE, FL 32901-3235
(321) 253-2700
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
12/24/2009
Last updated
10/11/2022
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