Provider Demographics
NPI:1346288974
Name:BEACHSIDE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:BEACHSIDE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-696-9353
Mailing Address - Street 1:660 E EAU GALLIE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4252
Mailing Address - Country:US
Mailing Address - Phone:321-773-5290
Mailing Address - Fax:321-773-5268
Practice Address - Street 1:13 E MELBOURNE AVE STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5976
Practice Address - Country:US
Practice Address - Phone:321-425-4321
Practice Address - Fax:321-419-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK5288OtherMEDICARE RAILROAD
FL162869100OtherUS DOL GROUP ID
FLY906GOtherBCBS GROUP ID
FLCK5288OtherMEDICARE RAILROAD