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General NPI Number Information
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NPI Number | 1740657709
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE PHYSICAL THERAPY, OCCUPATIONAL THERAPY & SPEECH LANGUAGE
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 35 RAILROAD AVE BOX 1264
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City | CENTER MORICHES
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State | NY
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Zip | 11934-6000
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Country | US
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Telephone | 631-841-3899
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1264
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City | CENTER MORICHES
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State | NY
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Zip | 11934-7264
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. TIMOTHY GLOVER
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Credential |
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Telephone | 631-848-9108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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