Provider Demographics
NPI:1992724496
Name:BAYONNE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:BAYONNE PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:239-352-9884
Mailing Address - Street 1:5263 GOLDEN GATE PKWY
Mailing Address - Street 2:UNITE E
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7601
Mailing Address - Country:US
Mailing Address - Phone:239-352-9884
Mailing Address - Fax:239-352-8610
Practice Address - Street 1:3906 TAMIAMI TRAIL EAST
Practice Address - Street 2:STE A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6251
Practice Address - Country:US
Practice Address - Phone:239-530-0201
Practice Address - Fax:239-530-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL991798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCG7750OtherMEDICARE RAILROAD
FLY905MOtherBLUE CROSS & BLUE SHIELD
FLY905MOtherBLUE CROSS & BLUE SHIELD