Provider Demographics
NPI:1851172779
Name:SHINE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SHINE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER/DPT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-806-0756
Mailing Address - Street 1:3400 VICKERY RD STE E
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4526
Mailing Address - Country:US
Mailing Address - Phone:315-806-0756
Mailing Address - Fax:
Practice Address - Street 1:3400 VICKERY RD STE E
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4526
Practice Address - Country:US
Practice Address - Phone:315-806-0756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty