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Organization

COASTLINE THERAPY GROUP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KIMBERLY FAYE BAGEANT (OWNER, CFO)
(910) 461-9168
Entity
Organization

Contact information

Practice address
3901 WRIGHTSVILLE AVE STE 120, WILMINGTON, NC 28403-6256
(910) 679-8385
(910) 679-8387
Mailing address
1468 EASTBOURNE DR, WILMINGTON, NC 28411-8431
(910) 461-9168

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2251P0200X
Pediatric Physical Therapist
225X00000X
Occupational Therapist
10745
NC
225X00000X
Occupational Therapist
235Z00000X
Speech-Language Pathologist
12318
NC
235Z00000X
Speech-Language Pathologist
Primary

Other

Enumeration date
02/28/2018
Last updated
01/17/2020
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