Provider Demographics
NPI:1659411692
Name:SOUTHERN OCEAN SPORTS TRAINING, P.C.
Entity Type:Organization
Organization Name:SOUTHERN OCEAN SPORTS TRAINING, P.C.
Other - Org Name:SOUTHERN OCEAN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:732-473-1666
Mailing Address - Street 1:9 MULE RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5043
Mailing Address - Country:US
Mailing Address - Phone:732-473-1666
Mailing Address - Fax:732-473-1601
Practice Address - Street 1:9 MULE RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5043
Practice Address - Country:US
Practice Address - Phone:732-473-1666
Practice Address - Fax:732-473-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094914Medicare PIN
NJ078920UNEMedicare UPIN
NJ316666Medicare Oscar/Certification