Provider Demographics
NPI:1336145283
Name:SHORE ORTHOPEDIC & ATHLETIC REHABILITATION, PA
Entity Type:Organization
Organization Name:SHORE ORTHOPEDIC & ATHLETIC REHABILITATION, PA
Other - Org Name:S.O.A.R. PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-449-2001
Mailing Address - Street 1:2123 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1003
Mailing Address - Country:US
Mailing Address - Phone:732-449-2001
Mailing Address - Fax:732-449-2238
Practice Address - Street 1:2123 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1003
Practice Address - Country:US
Practice Address - Phone:732-449-2001
Practice Address - Fax:732-449-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ541315Medicare ID - Type Unspecified