Provider Demographics
NPI:1033243936
Name:HARBOR CITY PHYSICAL THERAPY, PA
Entity Type:Organization
Organization Name:HARBOR CITY PHYSICAL THERAPY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHNEYDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:321-953-3991
Mailing Address - Street 1:307 E NEW HAVEN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4576
Mailing Address - Country:US
Mailing Address - Phone:321-953-3991
Mailing Address - Fax:321-953-3951
Practice Address - Street 1:307 E NEW HAVEN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4576
Practice Address - Country:US
Practice Address - Phone:321-953-3991
Practice Address - Fax:321-953-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLPT18001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY918XOtherBCBS PROVIDER NUMBER
FL331012OtherWELLCARE PROVIDER NUMBER
FL891232700Medicaid
FLK9101Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER