Provider Demographics
NPI:1699206508
Name:BAYSIDE PHYSICAL THERAPY & SPORTS REHABILITATION LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:BAYSIDE PHYSICAL THERAPY & SPORTS REHABILITATION LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:202 COURSEVALL DR
Mailing Address - Street 2:SUITE 111 & 112
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-2804
Mailing Address - Country:US
Mailing Address - Phone:410-758-0018
Mailing Address - Fax:410-758-4031
Practice Address - Street 1:202 COURSEVALL DR
Practice Address - Street 2:SUITE 111 & 112
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2804
Practice Address - Country:US
Practice Address - Phone:410-758-0018
Practice Address - Fax:410-758-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty