Provider Demographics
NPI:1891884250
Name:WEST COAST THERAPY, LLC
Entity type:Organization
Organization Name:WEST COAST THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISHKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-948-0041
Mailing Address - Street 1:23150 FASHION DR
Mailing Address - Street 2:SUITE T-240
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-8321
Mailing Address - Country:US
Mailing Address - Phone:239-948-0041
Mailing Address - Fax:239-948-0027
Practice Address - Street 1:25022 104TH AVE SE STE B
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2822
Practice Address - Country:US
Practice Address - Phone:253-856-0677
Practice Address - Fax:253-856-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA504506261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA504506Medicare ID - Type Unspecified