MEDICARE: OPTIMUM REHABILITATION SERVICES, INC.

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

General Provider Information

NPI Number	:	1437141025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM REHABILITATION SERVICES, INC.

Provider Business Mailing Address
First Line	:	360 S OAKHURST DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3506
Country	:	US
Telephone Number	:	310-625-9768
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 S OAKHURST DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3506
Country	:	US
Telephone Number	:	310-625-9768
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT - OPTIMUM REHAB SVCS, INC
Name	:	OLEG PROKOPENKO
Credential	:	PT
Telephone Number	:	310-625-9768

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	10/27/2019

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