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General NPI Number Information
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NPI Number | 1710917752
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Entity Type | Organization
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Legal Business Name | BEACH & FOSTER PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 222 E MAIN ST SUITE 340
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City | SMITHTOWN
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State | NY
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Zip | 11787-2871
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Country | US
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Telephone | 631-366-3025
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Fax | 631-366-3026
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Provider Business Mailing Address
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Address Line | 222 E MAIN ST SUITE 340
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City | SMITHTOWN
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State | NY
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Zip | 11787-2871
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Country | US
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Telephone | 631-366-3025
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Fax | 631-366-3026
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY J BEACH
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Credential | PT
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Telephone | 631-366-3025
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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 | 021777
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License Number State | NY
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