MEDICARE: BEACH FAMILY PHYSICAL THERAPY

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	261QH0100X	Health Service Clinic/Center	4551	CA
2	225700000X	Massage Therapist	4551	CA

General Provider Information

NPI Number	:	1629580188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH FAMILY PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	4132 DELPHI CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-2176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17610 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6855
Country	:	US
Telephone Number	:	714-580-2778
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL ANTHONY MCCORMICK
Credential	:	NMT
Telephone Number	:	714-580-2778

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	10/24/2017

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Directions to “BEACH FAMILY PHYSICAL THERAPY ” Practice Location

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