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NPI Code Detail

MEDICARE: BEACHSIDE PHYSICAL THERAPY INC

MEDICARE: BEACHSIDE PHYSICAL THERAPY INC
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
1225100000XPhysical Therapist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CK5288OTHERFLMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2162869100OTHERFLUS DOL GROUP ID
3Y906GOTHERFLBCBS GROUP ID

General Provider Information

NPI Number : 1346288974
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACHSIDE PHYSICAL THERAPY INC
Provider Business Mailing Address
First Line : 660 E EAU GALLIE BLVD STE 106
Second Line :
City : INDIAN HARBOUR BEACH
State : FL
Zip : 32937-4252
Country : US
Telephone Number : 321-773-5290
Fax Number : 321-773-5268
Provider Business Practice Location Address
First Line : 13 E MELBOURNE AVE STE A
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-5976
Country : US
Telephone Number : 321-425-4321
Fax Number : 321-419-0334
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : GABRIELA LITT
Credential :
Telephone Number : 951-696-9353
Provider Enumeration Date : 06/04/2006
Last Update Date : 05/25/2023

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Directions to “BEACHSIDE PHYSICAL THERAPY INC ” Practice Location

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