Healthcare Provider Details

I. General information

NPI: 1851597348
Provider Name (Legal Business Name): NORTHSHORE THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 GAUSE BLVD E
SLIDELL LA
70461-4247
US

IV. Provider business mailing address

2800 GAUSE BLVD E
SLIDELL LA
70461-4247
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-4263
  • Fax: 985-643-4774
Mailing address:
  • Phone: 985-643-4263
  • Fax: 985-643-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOTT.200062
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberOTT.200062
License Number StateLA

VIII. Authorized Official

Name: AMANDA MILLER
Title or Position: PRESIDENT
Credential: MOT, LOTR
Phone: 985-643-4263