Provider Demographics
NPI:1013203975
Name:GOLD COAST PHYSICAL THERAPISTS & THERAPY ASSISTANTS
Entity Type:Organization
Organization Name:GOLD COAST PHYSICAL THERAPISTS & THERAPY ASSISTANTS
Other - Org Name:GOLD COAST PHYSICAL THERAPY AND SPORTS TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTALING
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-262-7855
Mailing Address - Street 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-351-7676
Mailing Address - Fax:631-351-7667
Practice Address - Street 1:309 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-656-5665
Practice Address - Fax:631-656-5664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLD COAST PHYSICAL THERAPISTS AND THERAPY ASSISTANTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQOWLX1Medicare UPIN