Provider Demographics
NPI:1427084284
Name:PHYSICAL THERAPY AND AQUATICS BY THE SEA, PLLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND AQUATICS BY THE SEA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-766-0505
Mailing Address - Street 1:15 NEIL CT
Mailing Address - Street 2:INSIDE FRIEDBERG JCC
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5815
Mailing Address - Country:US
Mailing Address - Phone:516-766-0505
Mailing Address - Fax:516-766-0680
Practice Address - Street 1:11 NEIL CT
Practice Address - Street 2:INSIDE SUNRISE CENTER
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5815
Practice Address - Country:US
Practice Address - Phone:516-766-0505
Practice Address - Fax:516-766-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005253-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5WWW1Medicare UPIN