Healthcare Provider Details

I. General information

NPI: 1245398106
Provider Name (Legal Business Name): DEBORAH SHORE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA SHORE

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 BETHLEHEM PIKE SUITE 210
ERDENHEIM PA
19038-8111
US

IV. Provider business mailing address

2235 BRANDYWINE ST
PHILADELPHIA PA
19130-3108
US

V. Phone/Fax

Practice location:
  • Phone: 267-285-0067
  • Fax: 267-285-0069
Mailing address:
  • Phone: 215-557-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007003L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00828300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: