Provider Demographics
NPI:1578630679
Name:OCEAN ONE ENTERPRISES
Entity Type:Organization
Organization Name:OCEAN ONE ENTERPRISES
Other - Org Name:VARSITY REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-677-4300
Mailing Address - Street 1:495 S NOVA RD STE 113
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8470
Mailing Address - Country:US
Mailing Address - Phone:386-677-4300
Mailing Address - Fax:386-615-9216
Practice Address - Street 1:495 S NOVA RD STE 113
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8470
Practice Address - Country:US
Practice Address - Phone:386-677-4300
Practice Address - Fax:386-615-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0002188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650015987OtherMC RAIL ROAD
FL5132624OtherAETNA
FL1699893OtherGHI
FLPT2188OtherPT LICENCE
S72163Medicare UPIN