| Entity Name: | COAST PHYSICAL THERAPY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Jul 1993 (32 years ago) |
| Document Number: | P93000054166 |
| FEI/EIN Number | 593193276 |
| Address: | 500 N. WASHINGTON AVE., SUITE 107, TITUSVILLE, FL, 32796, US |
| Mail Address: | 500 N. WASHINGTON AVE., SUITE 107, TITUSVILLE, FL, 32796, US |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053483685 | 2006-11-15 | 2024-02-22 | 500 N. WASHINGTON AVE, STE 107, TITUSVILLE, FL, 32796, US | 500 N. WASHINGTON AVE, STE 107, TITUSVILLE, FL, 32796, US | |||||||||||||||||||||||
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| Phone | +1 321-269-0800 |
| Fax | 3213830404 |
Authorized person
| Name | MICHAEL ALAN JOHNSON |
| Role | OWNER/PHYSICAL THERAPIST |
| Phone | 3216072454 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 886365200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSON MICHAEL A | Agent | 2618 Cherrywood Lane, TITUSVILLE, FL, 32780 |
| Name | Role | Address |
|---|---|---|
| Johnson Michael A | President | 2618 Cherrywood Lane, Titusville, FL, 32780 |
| Name | Role | Address |
|---|---|---|
| Johnson Elizabeth A | Secretary | 2618 Cherrywood Lane, Titusville, FL, 32780 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
