Healthcare Provider Details

I. General information

NPI: 1225018617
Provider Name (Legal Business Name): SHORE WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MONMOUTH RD
OAKHURST NJ
07755-1515
US

IV. Provider business mailing address

255 MONMOUTH RD
OAKHURST NJ
07755-1515
US

V. Phone/Fax

Practice location:
  • Phone: 732-660-1560
  • Fax: 732-660-1562
Mailing address:
  • Phone: 732-660-1560
  • Fax: 732-660-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL R SANTAMARIA
Title or Position: PRESIDENT
Credential: MPT
Phone: 732-660-1560