Provider Demographics
NPI:1366251597
Name:COASTAL PHYSICAL THERAPY & BALANCE CENTER INC
Entity type:Organization
Organization Name:COASTAL PHYSICAL THERAPY & BALANCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAKUCEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:401-714-5023
Mailing Address - Street 1:576 METACOM AVE STE 9&10
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-5100
Mailing Address - Country:US
Mailing Address - Phone:401-253-1353
Mailing Address - Fax:401-253-8320
Practice Address - Street 1:576 METACOM AVE STE 9&10
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-5100
Practice Address - Country:US
Practice Address - Phone:401-253-1353
Practice Address - Fax:401-253-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy