Provider Demographics
NPI:1750422705
Name:SOUTH SHORE PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:SOUTH SHORE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-878-4545
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3504
Mailing Address - Country:US
Mailing Address - Phone:631-878-4545
Mailing Address - Fax:631-878-4573
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3504
Practice Address - Country:US
Practice Address - Phone:631-878-4545
Practice Address - Fax:631-878-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5685-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1310650OtherUNITED HEALTH CARE
NY51503OtherAETNA
NY130065OtherMPN
NY3989276OtherCIGNA
NY970755OtherHIP
NY50175Medicare UPIN
NY130065OtherMPN