Basic Information
| Provider Information | |||||||||
| NPI: | 1154770857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOLEY | ||||||||
| FirstName: | SHANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 POST RD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | DARIEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068204622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034220679 | ||||||||
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| Practice Location | |||||||||
| Address1: | 35 RIVER RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | COS COB | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068072759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034220679 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2016 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14.011008 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.