Provider Demographics
NPI:1275621369
Name:LONG BEACH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:LONG BEACH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BOZLEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-867-8882
Mailing Address - Street 1:5132 BEATLINE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-3869
Mailing Address - Country:US
Mailing Address - Phone:228-867-8882
Mailing Address - Fax:228-867-8810
Practice Address - Street 1:5132 BEATLINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3869
Practice Address - Country:US
Practice Address - Phone:228-867-8882
Practice Address - Fax:228-867-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1109261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherTRIWEST