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Organization
SEASIDE PHYSICAL THERAPY LLC
Active
Organization
SEASIDE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH DE JONG PT (CO-OWNER)
(252) 261-6489
Entity
Organization
Contact information
Practice address
6365 N CROATAN HWY, SUITE C, KITTY HAWK, NC 27949-3800
(252) 261-6489
(252) 261-6489
Mailing address
6365 N CROATAN HWY, SUITE C, KITTY HAWK, NC 27949-3800
(252) 261-6489
(252) 261-6489
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5494
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016G8
BCBS GROUP ID
NC
Enumeration date
10/11/2006
Last updated
11/08/2007
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