Provider Demographics
NPI:1235100587
Name:BAY PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:BAY PHYSICAL THERAPY, PC
Other - Org Name:BAY PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLICKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-998-7586
Mailing Address - Street 1:2350 OCEAN AVE
Mailing Address - Street 2:SUITE5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3044
Mailing Address - Country:US
Mailing Address - Phone:718-998-7586
Mailing Address - Fax:718-998-3374
Practice Address - Street 1:2350 OCEAN AVE
Practice Address - Street 2:SUITE5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3044
Practice Address - Country:US
Practice Address - Phone:718-998-7586
Practice Address - Fax:718-998-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ2WTS1Medicare ID - Type UnspecifiedPHYSICAL THERAPY PRACTICE