Provider Demographics
NPI:1619037298
Name:GOLD COAST PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANT PLLC
Entity Type:Organization
Organization Name:GOLD COAST PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANT PLLC
Other - Org Name:GOLD COAST PHYSICAL THERAPIST & SPORTS TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-351-7676
Mailing Address - Street 1:755 NEW YORK AVENUE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4240
Mailing Address - Country:US
Mailing Address - Phone:631-351-7676
Mailing Address - Fax:631-351-7667
Practice Address - Street 1:92 BROADWAY
Practice Address - Street 2:STE 102
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1328
Practice Address - Country:US
Practice Address - Phone:631-351-7676
Practice Address - Fax:631-351-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0WLX2Medicare ID - Type Unspecified