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General NPI Number Information
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NPI Number | 1881144673
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Entity Type | Organization
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Legal Business Name | BEACH POINT PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 8873 ADAMS AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-3301
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Country | US
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Telephone | 714-600-1758
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Fax |
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Provider Business Mailing Address
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Address Line | 8873 ADAMS AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-3301
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Country | US
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Telephone | 714-600-1758
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. RODIEL KIRBY LAYSON BALOY II
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Credential | PT, DPT, MS, CSCS
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Telephone | 714-600-1758
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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 | PT34304
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License Number State | CA
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