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General NPI Number Information
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NPI Number | 1780360560
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Entity Type | Organization
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Legal Business Name | SHORE STRIDE LLC
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 35247 ATLANTIC AVE UNIT 2
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City | MILLVILLE
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State | DE
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Zip | 19945
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Country | US
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Telephone | 302-402-3156
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Fax | 302-213-6057
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Provider Business Mailing Address
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Address Line | 31022 WHITES NECK RD
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City | OCEAN VIEW
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State | DE
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Zip | 19970
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Country | US
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Telephone | 443-513-1028
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | NICOLE EVANS
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Credential | DPT
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Telephone | 443-513-1028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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