Organization
SHORELINE ORTHOPEDIC REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG COOPER (MANAGING PARTNER)
(219) 365-6560
Entity
Organization
Contact information
Practice address
12 BOKUM RD, ESSEX, CT 06426-1500
(860) 767-9035
Mailing address
8259 WICKER AVE, SAINT JOHN, IN 46373-8878
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
08/09/2006
Last updated
02/21/2008
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