Healthcare Provider Details

I. General information

NPI: 1902738297
Provider Name (Legal Business Name): SHORELINE TELEPT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 SPEYER LN
REDONDO BEACH CA
90278-4814
US

IV. Provider business mailing address

2629 MANHATTAN AVE # 1015
HERMOSA BEACH CA
90254-2411
US

V. Phone/Fax

Practice location:
  • Phone: 213-282-7058
  • Fax:
Mailing address:
  • Phone: 213-282-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN MCCLURG
Title or Position: CEO
Credential: PT
Phone: 310-403-1583