Provider Demographics
| NPI: | 1942361522 |
|---|---|
| Name: | COASTAL ORTHOPEDICS AND SPORTS MEDICINE OF SOUTHWEST FLORIDA P.A. |
| Entity type: | Organization |
| Organization Name: | COASTAL ORTHOPEDICS AND SPORTS MEDICINE OF SOUTHWEST FLORIDA P.A. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CREDENTIALING SURPERVISOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | NANCY |
| Authorized Official - Middle Name: | R |
| Authorized Official - Last Name: | BORGGREN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 941-782-0102 |
| Mailing Address - Street 1: | 8000 STATE ROAD 64 E |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BRADENTON |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 34212-7703 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 941-792-1404 |
| Mailing Address - Fax: | 941-794-1863 |
| Practice Address - Street 1: | 8000 STATE ROAD 64 E |
| Practice Address - Street 2: | |
| Practice Address - City: | BRADENTON |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 34212-7703 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 941-792-1404 |
| Practice Address - Fax: | 941-794-1863 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-12-13 |
| Last Update Date: | 2025-02-10 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 225000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | Group - Multi-Specialty | |
| No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Multi-Specialty |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
