Provider Demographics
NPI:1700052503
Name:OCEAN PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:OCEAN PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:999-999-9999
Mailing Address - Street 1:861 VIA DE LA PAZ STE F
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-5208
Mailing Address - Country:US
Mailing Address - Phone:999-999-9999
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:861 VIA DE LA PAZ STE F
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-5208
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty