Provider Demographics
NPI:1679217368
Name:CORE THERAPY SERVICES PT OT PLLC
Entity Type:Organization
Organization Name:CORE THERAPY SERVICES PT OT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAOUL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-723-0687
Mailing Address - Street 1:2003 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2328
Mailing Address - Country:US
Mailing Address - Phone:347-394-1600
Mailing Address - Fax:
Practice Address - Street 1:2003 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2328
Practice Address - Country:US
Practice Address - Phone:347-394-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty