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General NPI Number Information
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NPI Number | 1861033466
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Entity Type | Organization
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Legal Business Name | BAYSIDE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 341 GREENO RD N STE 102
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City | FAIRHOPE
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State | AL
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Zip | 36532-2979
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Country | US
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Telephone | 251-928-9954
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 927
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City | FAIRHOPE
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State | AL
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Zip | 36533-0927
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Country | US
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Telephone | 251-928-9954
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Fax | 251-210-3216
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Authorized Official
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Title or Position | CEO
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Name | ROBERT STANLEY
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Credential |
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Telephone | 251-210-3210
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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 |
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License Number State |
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Taxonomy #2
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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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