Provider Demographics
NPI:1700480464
Name:COVESIDE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:COVESIDE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-735-7507
Mailing Address - Street 1:57 CHARLESTON RD
Mailing Address - Street 2:
Mailing Address - City:CHEBEAGUE ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04017-3628
Mailing Address - Country:US
Mailing Address - Phone:508-735-7507
Mailing Address - Fax:207-846-1696
Practice Address - Street 1:57 CHARLESTON RD
Practice Address - Street 2:
Practice Address - City:CHEBEAGUE ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04017-3628
Practice Address - Country:US
Practice Address - Phone:508-735-7507
Practice Address - Fax:207-846-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty