Healthcare Provider Details

I. General information

NPI: 1760540371
Provider Name (Legal Business Name): BEACH PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 MONTAUK HWY
EAST MORICHES NY
11940-1172
US

IV. Provider business mailing address

43 SOUTH ST P.O. BOX 626
MANORVILLE NY
11949-8501
US

V. Phone/Fax

Practice location:
  • Phone: 631-874-6860
  • Fax: 631-874-6861
Mailing address:
  • Phone: 631-874-6860
  • Fax: 631-874-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021777
License Number StateNY

VIII. Authorized Official

Name: MR. GREGORY JAMES BEACH
Title or Position: OWNER
Credential: P.T.
Phone: 631-874-6860