1467571620 NPI number — OCEAN PHYSICAL THERAPY LLC

Table of content: (NPI 1467571620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467571620 NPI number — OCEAN PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN PHYSICAL THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467571620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 FAIRWAY DR STE 27
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33418-3782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-775-7775
Provider Business Mailing Address Fax Number:
561-775-7807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
252 S OCEAN BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANTANA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-588-1343
Provider Business Practice Location Address Fax Number:
561-588-1462
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHMAN
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
561-775-7775

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y928M . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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