Provider Demographics
NPI:1245398106
Name:SHORE, DEBORAH (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:SHORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:SHORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2235 BRANDYWINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3108
Mailing Address - Country:US
Mailing Address - Phone:215-557-7768
Mailing Address - Fax:
Practice Address - Street 1:717 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 210
Practice Address - City:ERDENHEIM
Practice Address - State:PA
Practice Address - Zip Code:19038-8111
Practice Address - Country:US
Practice Address - Phone:267-285-0067
Practice Address - Fax:267-285-0069
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007003L225100000X
NJ40QA00828300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA430583OtherPA BLUE SHIELD PROVIDER #
PW022287Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER