MEDICARE: SHINE PHYSICAL AND OCCUPATIONAL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225200000X	Physical Therapy Assistant
3	225X00000X	Occupational Therapist
4	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1356007801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINE PHYSICAL AND OCCUPATIONAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	1276 E 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4822
Country	:	US
Telephone Number	:	646-388-2285
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 E 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4822
Country	:	US
Telephone Number	:	646-388-2285
Fax Number	:	718-252-0615

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOEY WEISS
Credential	:	PT, DPT
Telephone Number	:	646-388-2285

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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