MEDICARE: OCEAN PARK ORTHOPEDIC AND SPORTS THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1598791196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN PARK ORTHOPEDIC AND SPORTS THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 184
Second Line	:
City	:	WASHINGTON
State	:	VA
Zip	:	22747-0184
Country	:	US
Telephone Number	:	540-675-3090
Fax Number	:	540-675-3058

Provider Business Practice Location Address
First Line	:	261 MAIN STREET
Second Line	:
City	:	WASHINGTON
State	:	VA
Zip	:	22747-0184
Country	:	US
Telephone Number	:	540-675-3090
Fax Number	:	540-675-3058

Authorized Official
Title or Position	:	OFFICER
Name	:	MR. THOMAS MARK PAPKE
Credential	:	P.T.
Telephone Number	:	540-675-3090

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	10/21/2009

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Directions to “OCEAN PARK ORTHOPEDIC AND SPORTS THERAPY ” Practice Location

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