1659687267 NPI number — COASTAL PHYSICAL THERAPY SERVICES, LLC

Table of content: MR. SHAHBAZ ALI CHEEMA MD (NPI 1922079508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659687267 NPI number — COASTAL PHYSICAL THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL PHYSICAL THERAPY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659687267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRINGTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04643-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-483-4022
Provider Business Mailing Address Fax Number:
207-483-9722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRINGTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-271-7302
Provider Business Practice Location Address Fax Number:
207-483-2222
Provider Enumeration Date:
08/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
BEAL
Authorized Official Title or Position:
OWNER/DPT
Authorized Official Telephone Number:
207-483-4022

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT2403 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1508823345 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 249640099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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