| Organization Name: | SEASIDE PHYSICAL THERAPY LLC |
| NPI Number: | 1326136797 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELLEN ELIZABETH DE JONG (CO-OWNER) |
| Mailing Address: | 6365 N Croatan Hwy Suite C Kitty Hawk |
| State: | NC US |
| Postal Code: | 279493800 |
| Phone Number: | 2522616489 |
| Fax Number: | 2522616489 |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 11/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5494 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |