Provider Demographics
NPI:1811093313
Name:SHORE MOVEMENT PHYSICAL THERAPY, P.A.
Entity type:Organization
Organization Name:SHORE MOVEMENT PHYSICAL THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHACEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:302-645-6470
Mailing Address - Street 1:270 COMMERCE DR
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2405
Mailing Address - Country:US
Mailing Address - Phone:215-654-1520
Mailing Address - Fax:215-654-1529
Practice Address - Street 1:1310 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1526
Practice Address - Country:US
Practice Address - Phone:302-645-6470
Practice Address - Fax:302-645-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2005211300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02297Medicare ID - Type Unspecified