Provider Demographics
NPI:1831306588
Name:ISLAND SHORE PHYSICAL THERAPY, LLP
Entity Type:Organization
Organization Name:ISLAND SHORE PHYSICAL THERAPY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-277-9283
Mailing Address - Street 1:174 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2633
Mailing Address - Country:US
Mailing Address - Phone:631-277-9283
Mailing Address - Fax:631-277-9394
Practice Address - Street 1:174 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2633
Practice Address - Country:US
Practice Address - Phone:631-277-9283
Practice Address - Fax:631-277-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty