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General NPI Number Information
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NPI Number | 1750422705
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 220 MAIN ST SUITE 3
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City | CENTER MORICHES
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State | NY
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Zip | 11934-3504
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Country | US
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Telephone | 631-878-4545
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Fax | 631-878-4573
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Provider Business Mailing Address
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Address Line | 220 MAIN ST SUITE 3
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City | CENTER MORICHES
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State | NY
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Zip | 11934-3504
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Country | US
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Telephone | 631-878-4545
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Fax | 631-878-4573
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM M. HERRO
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Credential | P.T.
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Telephone | 631-878-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5685-1
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License Number State | NY
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