Beach Wellness Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

BEACH WELLNESS PHYSICAL THERAPY, LLC

Practice address

522 W Beech St
Long Beach, NY 11561-3010

Phone

(516) 330-9213

NPI assigned

Sep 19, 2023

Last updated

Sep 19, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lacey Cavallo, PTNPI 1497281836

Title

Owner

Phone

(516) 330-9213

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lacey Cavallo, DPT

  • Physical Therapist
  • Long Beach, NY
  • NPI 1497281836
  Medicare reassignment Care Compare group NPD Authorized official
• Colleen Mary Bennett, P.T.

  • Physical Therapist
  • Locust Valley, NY
  • NPI 1578694279
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1396523585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 W BEECH ST",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115613010",
            "telephone_number": "516-330-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 W BEECH ST",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115613010",
            "telephone_number": "516-330-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH WELLNESS PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "CAVALLO",
        "authorized_official_first_name": "LACEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-330-9213",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darlene Barry, LCSW
• Leland Stann Barry, OD
• Beach & Surf Medical, PC
• Beach Primary Medicine PC
• Beach Terrace Care Center Inc
• Beachside Mental Health Counseling, PLLC
• Beachside Mental Health Counseling, PLLC
• Bed Pharmacy East, LLC (Kings Pharmacy)
• Bed West, LLC (Kings Pharmacy)
• Jerry Bedor, DDS

• Physical Therapy Clinic/Center in Long Beach, NY
• Providers in Long Beach, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.