Provider Demographics
NPI:1013084557
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:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-677-4300
Mailing Address - Street 1:495 S NOVA RD
Mailing Address - Street 2:SUITE 112
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:
Practice Address - Street 1:1714 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8339
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:2006-11-29
Last Update Date:2007-09-19
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
FLPT0002188OtherPT LICENSE NO
FL1699893OtherGHI
FL5132624OtherAETNA
FL1699893OtherGHI
FLS72163Medicare UPIN