Provider Demographics
NPI:1396895512
Name:OCEAN PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:OCEAN PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-366-6785
Mailing Address - Street 1:901 CALLE AMANECER
Mailing Address - Street 2:STE 320
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6278
Mailing Address - Country:US
Mailing Address - Phone:949-366-6785
Mailing Address - Fax:949-366-6470
Practice Address - Street 1:901 CALLE AMANECER
Practice Address - Street 2:STE 320
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6278
Practice Address - Country:US
Practice Address - Phone:949-366-6785
Practice Address - Fax:949-366-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15153Medicare ID - Type UnspecifiedGROUP NUMBER