=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033243936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARBOR CITY PHYSICAL THERAPY, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 01/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 E NEW HAVEN AVE SUITE 2
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901-4576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-953-3991
-----------------------------------------------------
Fax | 321-953-3951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 307 E NEW HAVEN AVE SUITE 2
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901-4576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-953-3991
-----------------------------------------------------
Fax | 321-953-3951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PT
-----------------------------------------------------
Name | LAWRENCE MICHAEL SHNEYDER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 321-953-3991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | FLPT18001
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------