Provider Demographics
NPI:1013514306
Name:SHORESIDE IN HOME THERAPY
Entity Type:Organization
Organization Name:SHORESIDE IN HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:609-276-0538
Mailing Address - Street 1:213 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2655
Mailing Address - Country:US
Mailing Address - Phone:609-276-0538
Mailing Address - Fax:
Practice Address - Street 1:213 19TH AVE
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2655
Practice Address - Country:US
Practice Address - Phone:609-276-0538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty