Provider Demographics
NPI:1255514824
Name:SOUTH SHORE ORTHOPEDICS, LLC
Entity type:Organization
Organization Name:SOUTH SHORE ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-337-5555
Mailing Address - Street 1:2 POND PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4354
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:
Practice Address - Street 1:2 POND PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4354
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty