Provider Demographics
NPI:1073541074
Name:PEBBLE BEACH PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:PEBBLE BEACH PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FTAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-946-3304
Mailing Address - Street 1:5 PEBBLE BEACH LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5117
Mailing Address - Country:US
Mailing Address - Phone:914-946-3304
Mailing Address - Fax:
Practice Address - Street 1:5 PEBBLE BEACH LN
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5117
Practice Address - Country:US
Practice Address - Phone:914-946-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0046431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty