Provider Demographics
NPI:1104443837
Name:COASTAL PHYSICAL THERAPY AND SPORTS REHABILITATION
Entity type:Organization
Organization Name:COASTAL PHYSICAL THERAPY AND SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-497-0817
Mailing Address - Street 1:258 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5806
Mailing Address - Country:US
Mailing Address - Phone:805-497-0817
Mailing Address - Fax:805-497-8933
Practice Address - Street 1:258 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5806
Practice Address - Country:US
Practice Address - Phone:805-497-0817
Practice Address - Fax:805-497-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty