Provider Demographics
NPI:1033241302
Name:GOLD COAST PHYSICAL THERAPIST AND PHYSICAL THERAPY ASSISTANT PLLC
Entity Type:Organization
Organization Name:GOLD COAST PHYSICAL THERAPIST AND PHYSICAL THERAPY ASSISTANT PLLC
Other - Org Name:GOLD COAST PHYSICAL THERAPY AND SPORTS TRAININ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERACI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-486-5286
Mailing Address - Street 1:5036 JERICHO TPKE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2812
Mailing Address - Country:US
Mailing Address - Phone:631-486-5286
Mailing Address - Fax:631-486-5287
Practice Address - Street 1:5036 JERICHO TPKE
Practice Address - Street 2:SUITE 301
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2812
Practice Address - Country:US
Practice Address - Phone:631-486-5286
Practice Address - Fax:631-486-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty