Provider Demographics
NPI:1619142155
Name:MCSHANE, SARAH LOUISE (MAPT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LOUISE
Last Name:MCSHANE
Suffix:
Gender:F
Credentials:MAPT
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:LOUISE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAPT
Mailing Address - Street 1:13 SOUTH CARLL AVENUE
Mailing Address - Street 2:B-WELL PHYSICAL THERAPY & MASSAGE THERAPY PLLC
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-587-3828
Mailing Address - Fax:631-587-3588
Practice Address - Street 1:13 SOUTH CARLL AVENUE
Practice Address - Street 2:B-WELL PHYSICAL THERAPY & MASSAGE THERAPY PLLC
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-587-3828
Practice Address - Fax:631-587-3588
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11836091OtherCAQH