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General NPI Number Information
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NPI Number | 1366641193
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Entity Type | Organization
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Legal Business Name | SEASIDE PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3961 LONG BEACH RD
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City | ISLAND PARK
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State | NY
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Zip | 11558-1127
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Country | US
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Telephone | 516-897-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 3961 LONG BEACH RD
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City | ISLAND PARK
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State | NY
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Zip | 11558-1127
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Country | US
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Telephone | 516-897-9700
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Fax | 516-897-0529
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH FRANCIS SULLIVAN
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Credential | PT, OCS, CSCS
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Telephone | 516-599-8734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NY
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