1245398106 NPI number — MS. DEBORAH SHORE P.T.

Table of content: MS. DEBORAH SHORE P.T. (NPI 1245398106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245398106 NPI number — MS. DEBORAH SHORE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHORE
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHORE
Provider Other First Name:
DEBRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245398106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2235 BRANDYWINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19130-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-557-7768
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 BETHLEHEM PIKE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ERDENHEIM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19038-8111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-285-0067
Provider Business Practice Location Address Fax Number:
267-285-0069
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT007003L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 40QA00828300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 430583 . This is a "PA BLUE SHIELD PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com