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General NPI Number Information
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NPI Number | 1922897479
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Entity Type | Organization
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Legal Business Name | BAYSIDE THERAPY
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 2075 MEADOWLANE AVE
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City | MELBOURNE
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State | FL
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Zip | 32904-4951
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Country | US
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Telephone | 321-806-9395
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Fax |
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Provider Business Mailing Address
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Address Line | 674 OLD COUNTRY RD SE
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City | PALM BAY
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State | FL
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Zip | 32909-6903
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Country | US
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Telephone | 321-806-9395
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CRYSTAL YOUNG
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Credential | COTA/L
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Telephone | 321-806-9395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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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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Taxonomy #3
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Taxonomy Code | 2251C2600X
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Taxonomy Name | Cardiopulmonary Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2251E1200X
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Taxonomy Name | Ergonomics Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 2278P3900X
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Taxonomy Name | Neonatal/Pediatric Certified Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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