Healthcare Provider Details

I. General information

NPI: 1598791196
Provider Name (Legal Business Name): OCEAN PARK ORTHOPEDIC AND SPORTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 MAIN STREET
WASHINGTON VA
22747-0184
US

IV. Provider business mailing address

PO BOX 184
WASHINGTON VA
22747-0184
US

V. Phone/Fax

Practice location:
  • Phone: 540-675-3090
  • Fax: 540-675-3058
Mailing address:
  • Phone: 540-675-3090
  • Fax: 540-675-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS MARK PAPKE
Title or Position: OFFICER
Credential: P.T.
Phone: 540-675-3090