Provider Demographics
NPI:1922578434
Name:SHORT, ROREY (PTA)
Entity Type:Individual
Prefix:
First Name:ROREY
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SCRABBLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3016
Mailing Address - Country:US
Mailing Address - Phone:401-294-6183
Mailing Address - Fax:
Practice Address - Street 1:250 SCRABBLETOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3016
Practice Address - Country:US
Practice Address - Phone:401-294-6183
Practice Address - Fax:401-294-6169
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA01240208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation