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General NPI Number Information
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NPI Number | 1699713222
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Entity Type | Organization
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Legal Business Name | BEACHSIDE PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 3680 N WICKHAM RD STE B
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City | MELBOURNE
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State | FL
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Zip | 32935-2327
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Country | US
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Telephone | 321-255-5500
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Fax | 321-255-5551
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Provider Business Mailing Address
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Address Line | 660 E EAU GALLIE BLVD STE 106
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4252
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Country | US
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Telephone | 321-773-5290
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Fax | 321-773-5268
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | GABRIELA LITT
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Credential |
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Telephone | 951-696-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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