1619142155 NPI number — MRS. SARAH LOUISE MCSHANE MAPT

Table of content: MRS. SARAH LOUISE MCSHANE MAPT (NPI 1619142155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619142155 NPI number — MRS. SARAH LOUISE MCSHANE MAPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCSHANE
Provider First Name:
SARAH
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MAPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROOKS
Provider Other First Name:
SARAH
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619142155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 SOUTH CARLL AVENUE
Provider Second Line Business Mailing Address:
B-WELL PHYSICAL THERAPY & MASSAGE THERAPY PLLC
Provider Business Mailing Address City Name:
BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-587-3828
Provider Business Mailing Address Fax Number:
631-587-3588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 SOUTH CARLL AVENUE
Provider Second Line Business Practice Location Address:
B-WELL PHYSICAL THERAPY & MASSAGE THERAPY PLLC
Provider Business Practice Location Address City Name:
BABYLON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-587-3828
Provider Business Practice Location Address Fax Number:
631-587-3588
Provider Enumeration Date:
04/25/2008

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:  015418 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11836091 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".