Provider Demographics
NPI:1194586479
Name:SURFSIDE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:SURFSIDE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-454-0069
Mailing Address - Street 1:10 SURFSIDE CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2118
Mailing Address - Country:US
Mailing Address - Phone:714-454-0069
Mailing Address - Fax:714-475-3817
Practice Address - Street 1:10 SURFSIDE CT
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2118
Practice Address - Country:US
Practice Address - Phone:714-454-0069
Practice Address - Fax:714-475-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty