Provider Demographics
NPI:1174308571
Name:NORTHSHORE PHYSICAL THERAPY
Entity type:Organization
Organization Name:NORTHSHORE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ENGOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:504-655-2458
Mailing Address - Street 1:217 INTREPID DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-9110
Mailing Address - Country:US
Mailing Address - Phone:504-655-2458
Mailing Address - Fax:
Practice Address - Street 1:217 INTREPID DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-9110
Practice Address - Country:US
Practice Address - Phone:504-655-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty