Provider Demographics
NPI:1992761761
Name:SHINE, JOSEPH LEROY JR (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEROY
Last Name:SHINE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:301 W AIRLINE HWY
Mailing Address - Street 2:STE 104
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3823
Mailing Address - Country:US
Mailing Address - Phone:504-487-9422
Mailing Address - Fax:985-653-9324
Practice Address - Street 1:301 W AIRLINE HWY
Practice Address - Street 2:STE 104
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3823
Practice Address - Country:US
Practice Address - Phone:504-487-9422
Practice Address - Fax:985-653-9324
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LALA03237225100000X, 2251E1200X, 2251G0304X, 2251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X825CQ30Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER