MEDICARE: OPTIMUM HEALTH WELLNESS AND REHAB

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	225100000X	Physical Therapist	PT15114	FL

General Provider Information

NPI Number	:	1033598107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM HEALTH WELLNESS AND REHAB

Provider Business Mailing Address
First Line	:	5645 CORAL RIDGE DR
Second Line	:	SUITE 248
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3124
Country	:	US
Telephone Number	:	954-471-2582
Fax Number	:

Provider Business Practice Location Address
First Line	:	5645 CORAL RIDGE DR
Second Line	:	SUITE 248
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3124
Country	:	US
Telephone Number	:	954-471-2582
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAYETTE A SEWELL
Credential	:	PT
Telephone Number	:	954-471-2582

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	05/22/2015

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Directions to “OPTIMUM HEALTH WELLNESS AND REHAB ” Practice Location

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