Basic Information
| Provider Information | |||||||||
| NPI: | 1700052503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEAN PHYSICAL THERAPY & WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 VIA DE LA PAZ STE F | ||||||||
| Address2: | |||||||||
| City: | PACIFIC PALISADES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902725208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
| FaxNumber: | 9999999999 | ||||||||
| Practice Location | |||||||||
| Address1: | 861 VIA DE LA PAZ STE F | ||||||||
| Address2: | |||||||||
| City: | PACIFIC PALISADES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902725208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 02/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | SCHRADER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9999999999 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, MBA | ||||||||
| NPICertificationDate: | 02/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT20610 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.