Individual
MS. DEBORAH SHORE
Active
Individual
MS. DEBORAH SHORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
40QA00828300
NJ
225100000X
Physical Therapist
Primary
PT007003L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430583
PA BLUE SHIELD PROVIDER #
PA
Enumeration date
12/04/2006
Last updated
04/17/2014
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