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General NPI Number Information
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NPI Number | 1275621369
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Entity Type | Organization
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Legal Business Name | LONG BEACH PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5132 BEATLINE RD SUITE D
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City | LONG BEACH
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State | MS
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Zip | 39560-3869
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Country | US
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Telephone | 228-867-8882
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Fax | 228-867-8810
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Provider Business Mailing Address
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Address Line | 5132 BEATLINE RD SUITE D
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City | LONG BEACH
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State | MS
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Zip | 39560-3869
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Country | US
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Telephone | 228-867-8882
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Fax | 228-867-8810
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH Z BOZLEE
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Credential | P.T.
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Telephone | 228-867-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT1109
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License Number State | MS
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