MEDICARE: BEACH WELLNESS 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

General Provider Information

NPI Number	:	1396523585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH WELLNESS PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	522 W BEECH ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3010
Country	:	US
Telephone Number	:	516-330-9213
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 W BEECH ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3010
Country	:	US
Telephone Number	:	516-330-9213
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LACEY CAVALLO
Credential	:	PT
Telephone Number	:	516-330-9213

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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