Provider Demographics
NPI:1386322105
Name:SEACOAST MOBILE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SEACOAST MOBILE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STORCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:603-609-8830
Mailing Address - Street 1:422 CENTRAL AVE # 193
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3411
Mailing Address - Country:US
Mailing Address - Phone:603-609-8830
Mailing Address - Fax:
Practice Address - Street 1:422 CENTRAL AVE # 193
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3411
Practice Address - Country:US
Practice Address - Phone:603-609-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy