Coastal Pt | |
424 College Blvd, Valparaiso, FL 32580-1774 | |
(850) 378-2600 | |
(833) 869-6437 |
Full Name | Coastal Pt |
---|---|
Type | Facility |
Speciality | Physical Therapist |
Location | 424 College Blvd, Valparaiso, Florida |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679236806 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | (* (Not Available)) | Primary |
Provider Name | Traci D Green |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1316254477 PECOS PAC ID: 4486046638 Enrollment ID: I20220119003143 |
Mailing Address | Practice Location Address |
---|---|
Coastal Pt 6021 Sterling River Way, Niceville, FL 32578-1534 Ph: (850) 378-2600 | Coastal Pt 424 College Blvd, Valparaiso, FL 32580-1774 Ph: (850) 378-2600 |
Traci Duncan Green, MPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 424 College Blvd., Valparaiso, FL 32580 Phone: 850-378-2600 Fax: 833-869-6437 | |
Jennifer Leigh Gaddy, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 424 College Blvd, Valparaiso, FL 32580 Phone: 254-247-9064 Fax: 833-869-6437 |