Organization
COASTAL CAROLINA PHYSICAL REHAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAYRA ALFONSO MD (OWNER)
(843) 347-4175
Entity
Organization
Contact information
Practice address
235 SINGLETON RIDGE RD, SUITE 108, CONWAY, SC 29526
(843) 347-4175
(843) 347-4179
Mailing address
P O BOX 32217, MYRTLE BEACH, SC 29588
(843) 347-4175
(843) 347-4179
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD21577
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD21577
SC MEDICAL LICENSE
—
Enumeration date
12/12/2008
Last updated
12/12/2008
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