Provider Demographics
NPI:1760436034
Name:OCEANSIDE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:OCEANSIDE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:772-283-3820
Mailing Address - Street 1:931 SE OCEAN BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-283-3820
Mailing Address - Fax:772-283-3825
Practice Address - Street 1:931 SE OCEAN BLVD
Practice Address - Street 2:STE A
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-283-3820
Practice Address - Fax:772-283-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 17379261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5550Medicare PIN
FLK5550Medicare PIN