MEDICARE: DR. MATTHEW MORGAN SHINE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251E1200X	Ergonomics Physical Therapist	10306	LA
2	2251G0304X	Geriatric Physical Therapist	10306	LA
3	2251X0800X	Orthopedic Physical Therapist	10306	LA
4	225100000X	Physical Therapist	10306	LA

General Provider Information

NPI Number	:	1497531958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW MORGAN SHINE

Provider Business Mailing Address
First Line	:	PO BOX 309
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70069-0309
Country	:	US
Telephone Number	:	504-525-2225
Fax Number	:	504-324-8276

Provider Business Practice Location Address
First Line	:	4637 S CARROLLTON AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6024
Country	:	US
Telephone Number	:	504-525-2225
Fax Number	:	504-324-8276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	08/31/2023

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