Provider Demographics
NPI:1598791196
Name:OCEAN PARK ORTHOPEDIC AND SPORTS THERAPY
Entity Type:Organization
Organization Name:OCEAN PARK ORTHOPEDIC AND SPORTS THERAPY
Other - Org Name:CAPITOL METRO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PAPKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:540-675-3090
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22747-0184
Mailing Address - Country:US
Mailing Address - Phone:540-675-3090
Mailing Address - Fax:540-675-3058
Practice Address - Street 1:261 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:VA
Practice Address - Zip Code:22747-0184
Practice Address - Country:US
Practice Address - Phone:540-675-3090
Practice Address - Fax:540-675-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01698Medicare PIN