NPIMap

Organization Active NPI

Beachside Physical Therapy, Inc

  • Physical Therapist
  • Melbourne, FL
National Provider Identifier
1699713222
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BEACHSIDE PHYSICAL THERAPY, INC
Practice address
3680 N Wickham Rd
Ste B
Melbourne, FL 32935-2327
Phone
(321) 255-5500
Fax
(321) 255-5551
NPI assigned
Jun 4, 2006
Last updated
Apr 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Authorized official

Name
Gabriela Litt
Title
Credentialing Coordinator
Phone
(951) 696-9353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

3680 N Wickham Rd
Ste B
Melbourne, FL 32935-2327

Mailing address

660 E Eau Gallie Blvd Ste 106
Indian Harbour Beach, FL 32937-4252
Phone (321) 773-5290

Other identifiers 2

IdentifierTypeStateIssuer
Y912GOtherFLBCBS GROUP ID
162869100OtherFLUS DOL GROUP ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070605000506 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1052202769 Receives reassigned benefits from 11 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: W Melbourne, FL; Melbourne, FL; Indian Harbour Beach, FL

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Beachside Physical Therapy Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1699713222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 E EAU GALLIE BLVD STE 106",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329374252",
            "telephone_number": "321-773-5290",
            "fax_number": "321-773-5268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 N WICKHAM RD",
            "address_2": "STE B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329352327",
            "telephone_number": "321-255-5500",
            "fax_number": "321-255-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHSIDE PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "LITT",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "951-696-9353"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "Y912G",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DOL GROUP ID",
            "identifier": "162869100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; 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.