Provider Demographics
NPI:1700340296
Name:OCEANS BREEZE PHYSICAL MEDICINE CORP
Entity Type:Organization
Organization Name:OCEANS BREEZE PHYSICAL MEDICINE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-877-3429
Mailing Address - Street 1:170 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6714
Mailing Address - Country:US
Mailing Address - Phone:954-438-2694
Mailing Address - Fax:954-443-2142
Practice Address - Street 1:170 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6714
Practice Address - Country:US
Practice Address - Phone:954-438-2694
Practice Address - Fax:954-443-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center