Provider Demographics
NPI:1366641193
Name:SEASIDE PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:SEASIDE PHYSICAL THERAPY P.C.
Other - Org Name:PEAK PERFORMANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, CSCS
Authorized Official - Phone:516-599-8734
Mailing Address - Street 1:3961 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1127
Mailing Address - Country:US
Mailing Address - Phone:516-897-9700
Mailing Address - Fax:516-897-0529
Practice Address - Street 1:3961 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1127
Practice Address - Country:US
Practice Address - Phone:516-897-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXVRX1Medicare PIN