Provider Demographics
NPI:1538971999
Name:OCEANFRONT PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:OCEANFRONT PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:FETTEROLF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:757-403-6430
Mailing Address - Street 1:700 19TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4100
Mailing Address - Country:US
Mailing Address - Phone:757-403-6430
Mailing Address - Fax:
Practice Address - Street 1:700 19TH ST STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4100
Practice Address - Country:US
Practice Address - Phone:757-403-6430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty