Healthcare Provider Details

I. General information

NPI: 1013084557
Provider Name (Legal Business Name): OCEAN ONE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 STATE ROAD 44
NEW SMYRNA BEACH FL
32168-8339
US

IV. Provider business mailing address

495 S NOVA RD SUITE 112
ORMOND BEACH FL
32174-8470
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-4300
  • Fax: 386-615-9216
Mailing address:
  • Phone: 386-677-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0002188
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID E CARN
Title or Position: OWNER OPERATOR
Credential: PT
Phone: 386-677-4300