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Organization

COASTAL PHYSICAL THERAPY & SPORTS MEDICINE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. WILLIAM JEREMY BAILS MSPT, DPT (OWNER/CLINICAL DIRECTOR)
(410) 749-5050
Entity
Organization

Contact information

Practice address
1502 PEMBERTON DR STE C, SALISBURY, MD 21801-2475
(410) 749-5050
(410) 749-5057
Mailing address
1502 PEMBERTON DR STE C, SALISBURY, MD 21801-2475
(410) 749-5050
(410) 749-5057

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
20434
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
143839ZCMG
MEDICARE GROUP PROVIDER NUMBER
MD
Enumeration date
06/30/2008
Last updated
01/20/2021
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