Provider Demographics
NPI:1851382386
Name:SHORE SPINE & SPORT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SHORE SPINE & SPORT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-449-5858
Mailing Address - Street 1:2100 HIGHWAY 35
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1001
Mailing Address - Country:US
Mailing Address - Phone:732-449-5858
Mailing Address - Fax:732-449-7455
Practice Address - Street 1:2100 HIGHWAY 35
Practice Address - Street 2:SUITE C
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1001
Practice Address - Country:US
Practice Address - Phone:732-449-5858
Practice Address - Fax:732-449-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
078270Medicare UPIN