Organization
BEACHSIDE PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIELA LITT (CREDENTIALING COORDINATOR)
(951) 696-9353
Entity
Organization
Contact information
Practice address
4270 MINTON RD, STE 120, WEST MELBOURNE, FL 32904-9578
(321) 984-2933
(321) 953-5379
Mailing address
660 E EAU GALLIE BLVD SUITE 106, INDIAN HARBOUR BEACH, FL 32937-4400
(321) 773-5290
(321) 773-5268
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK5288
MEDICARE RAILROAD
FL
01
—
Y931E
BC/BS GROUP NUMBER
FL
Enumeration date
05/15/2008
Last updated
04/20/2021
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