Provider Demographics
NPI:1972251023
Name:COASTAL WELLNESS AND PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:COASTAL WELLNESS AND PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KANCHAN
Authorized Official - Middle Name:PHYSICAL
Authorized Official - Last Name:KHURANA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:310-424-0425
Mailing Address - Street 1:785 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1987
Mailing Address - Country:US
Mailing Address - Phone:310-424-0425
Mailing Address - Fax:
Practice Address - Street 1:785 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1987
Practice Address - Country:US
Practice Address - Phone:650-712-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty