Basic Information
| Provider Information | |||||||||
| NPI: | 1396895512 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEAN PHYSICAL THERAPY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 CALLE AMANECER | ||||||||
| Address2: | STE 320 | ||||||||
| City: | SAN CLEMENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926736278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493666785 | ||||||||
| FaxNumber: | 9493666470 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 CALLE AMANECER | ||||||||
| Address2: | STE 320 | ||||||||
| City: | SAN CLEMENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926736278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493666785 | ||||||||
| FaxNumber: | 9493666470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TREVINO | ||||||||
| AuthorizedOfficialFirstName: | LISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9493666785 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.