Provider Demographics
NPI:1508214586
Name:SHINE THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:SHINE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, OWNER
Authorized Official - Phone:309-258-0084
Mailing Address - Street 1:5016 N UNIVERSITY ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4781
Mailing Address - Country:US
Mailing Address - Phone:309-258-0084
Mailing Address - Fax:866-319-1546
Practice Address - Street 1:5016 N UNIVERSITY ST
Practice Address - Street 2:SUITE 109
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4781
Practice Address - Country:US
Practice Address - Phone:309-258-0084
Practice Address - Fax:866-319-1546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHINE THERAPY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty