Healthcare Provider Details

I. General information

NPI: 1447479563
Provider Name (Legal Business Name): SOUTH SHORE PEDIATRIC PHYSICAL THERAPY,LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 JERUSALEM AVE SUITE 106
NORTH BELLMORE NY
11710-1870
US

IV. Provider business mailing address

2415 JERUSALEM AVE SUITE 106
NORTH BELLMORE NY
11710-1870
US

V. Phone/Fax

Practice location:
  • Phone: 516-785-5257
  • Fax: 516-785-5154
Mailing address:
  • Phone: 516-785-5257
  • Fax: 516-785-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LINDA J FINNERAN
Title or Position: OWNER
Credential: PT,DPT,PCS
Phone: 516-785-5257