Provider Demographics
NPI:1609993948
Name:SHORE, JAMES S (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:S
Last Name:SHORE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:79 COLON AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1256
Mailing Address - Country:US
Mailing Address - Phone:904-806-6255
Mailing Address - Fax:904-819-5851
Practice Address - Street 1:212 SAN MARCO AVE
Practice Address - Street 2:STE C
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2773
Practice Address - Country:US
Practice Address - Phone:904-806-6255
Practice Address - Fax:904-819-5851
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32571225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist