Provider Demographics
NPI:1780360560
Name:SHORE STRIDE LLC
Entity type:Organization
Organization Name:SHORE STRIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:443-513-1028
Mailing Address - Street 1:31022 WHITES NECK RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970
Mailing Address - Country:US
Mailing Address - Phone:443-513-1028
Mailing Address - Fax:
Practice Address - Street 1:35247 ATLANTIC AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19945
Practice Address - Country:US
Practice Address - Phone:302-402-3156
Practice Address - Fax:302-213-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy