Healthcare Provider Details

I. General information

NPI: 1760436034
Provider Name (Legal Business Name): OCEANSIDE PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 SE OCEAN BLVD STE A
STUART FL
34994
US

IV. Provider business mailing address

931 SE OCEAN BLVD STE A
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-3820
  • Fax: 772-283-3825
Mailing address:
  • Phone: 772-283-3820
  • Fax: 772-283-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 17379
License Number StateFL

VIII. Authorized Official

Name: MR. BRYAN LESLIE GRAHAM
Title or Position: PRESIDENT
Credential: M.P.T.
Phone: 772-283-3820