Organization
COASTAL REHABILITATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTYN J YAGER DPT (OWNER)
(252) 338-2114
Entity
Organization
Contact information
Practice address
532C CARATOKE HIGHWAY, MOYOCK, NC 27958
(252) 435-6046
(252) 435-6210
Mailing address
101 MEDICAL DRIVE, ELIZABETH CITY, NC 27909-3361
(252) 338-2114
(252) 338-2115
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002W
BCBS FACILITY
—
01
—
07763
BCBS
—
05
—
7200037
—
NC
05
—
7700350
—
NC
Enumeration date
03/23/2007
Last updated
09/22/2022
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