Provider Demographics
NPI:1720233521
Name:SOUTH BEACH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SOUTH BEACH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-876-5200
Mailing Address - Street 1:103 MCCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4655
Mailing Address - Country:US
Mailing Address - Phone:718-876-5200
Mailing Address - Fax:718-876-5270
Practice Address - Street 1:103 MCCLEAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4655
Practice Address - Country:US
Practice Address - Phone:718-876-5200
Practice Address - Fax:718-876-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019429-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty