MEDICARE: LONG BEACH PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PT1109	MS

General Provider Information

NPI Number	:	1275621369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	5132 BEATLINE RD
Second Line	:	SUITE D
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3869
Country	:	US
Telephone Number	:	228-867-8882
Fax Number	:	228-867-8810

Provider Business Practice Location Address
First Line	:	5132 BEATLINE RD
Second Line	:	SUITE D
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3869
Country	:	US
Telephone Number	:	228-867-8882
Fax Number	:	228-867-8810

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ELIZABETH Z BOZLEE
Credential	:	P.T.
Telephone Number	:	228-867-8882

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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