Provider Demographics
NPI:1578871547
Name:SEASHORE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SEASHORE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-570-2400
Mailing Address - Street 1:1801 ATLANTIC AVENUE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401
Mailing Address - Country:US
Mailing Address - Phone:609-570-2400
Mailing Address - Fax:609-541-4131
Practice Address - Street 1:1801 ATLANTIC AVENUE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-570-2400
Practice Address - Fax:609-541-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00741100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1003857574OtherINDIVIDUAL NPI
NJ090271Medicare PIN