Provider Demographics
NPI:1336448505
Name:SCORE REHABILITATION PHYSICAL AND OCCUPATIONAL THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:SCORE REHABILITATION PHYSICAL AND OCCUPATIONAL THERAPY SERVICES, PLLC
Other - Org Name:SCORE REHABILITATION, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-450-2039
Mailing Address - Street 1:2307 30TH DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3595
Mailing Address - Country:US
Mailing Address - Phone:646-450-2039
Mailing Address - Fax:
Practice Address - Street 1:2307 30TH DR APT 1B
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3595
Practice Address - Country:US
Practice Address - Phone:646-450-2039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029386-1251E00000X
NY015173-1251E00000X
NY028564-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health