Provider Demographics
NPI:1790219392
Name:SHORE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:SHORE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:732-857-4473
Mailing Address - Street 1:79 SHADY NOOK DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5127
Mailing Address - Country:US
Mailing Address - Phone:732-857-4473
Mailing Address - Fax:732-847-4453
Practice Address - Street 1:79 SHADY NOOK DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5127
Practice Address - Country:US
Practice Address - Phone:732-857-4473
Practice Address - Fax:732-847-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00563600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty