Provider Demographics
NPI:1073257184
Name:SHORE GOLF PERFORMANCE & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SHORE GOLF PERFORMANCE & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:252-398-7457
Mailing Address - Street 1:5600 POST RD
Mailing Address - Street 2:SUITE 114 - PMB #362
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:252-398-7457
Mailing Address - Fax:
Practice Address - Street 1:69 BURLINGAME RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-2904
Practice Address - Country:US
Practice Address - Phone:252-398-7457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty