Omega 40 Sports Medicine

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT0000766 Issued in FL

Legal business name

OMEGA 40 SPORTS MEDICINE

Practice address

1 S Old Kings Rd
Ormond Beach, FL 32174-6177

Phone

(386) 672-4080

Fax

(386) 672-6197

NPI assigned

Aug 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Steve Xynidis, R.P.T.

Title

Owner

Phone

(386) 672-4080

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1053505529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S OLD KINGS RD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321746177",
            "telephone_number": "386-672-4080",
            "fax_number": "386-672-6197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S OLD KINGS RD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321746177",
            "telephone_number": "386-672-4080",
            "fax_number": "386-672-6197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEGA 40 SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-28",
        "last_updated": "2007-08-28",
        "status": "A",
        "authorized_official_last_name": "XYNIDIS",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-672-4080",
        "authorized_official_credential": "R.P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT0000766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.