Provider Demographics
NPI:1194276527
Name:COAST TO COAST REHABILITATION INC
Entity type:Organization
Organization Name:COAST TO COAST REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ABRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-797-7934
Mailing Address - Street 1:3650 TIMBERGLEN ROAD APT 3
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287
Mailing Address - Country:US
Mailing Address - Phone:817-797-7934
Mailing Address - Fax:
Practice Address - Street 1:8553 N BEACH ST
Practice Address - Street 2:SUITE 229
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4919
Practice Address - Country:US
Practice Address - Phone:817-797-7934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1215200305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization