MEDICARE: OPTIMUM PHYSICAL THERAPY, LLC

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	PT00009243	WA
2	225100000X	Physical Therapist	PT00008775	WA

General Provider Information

NPI Number	:	1972812675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	1027 REGENTS BLVD
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6030
Country	:	US
Telephone Number	:	253-202-6858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1027 REGENTS BLVD
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6030
Country	:	US
Telephone Number	:	253-202-6858
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	SHANNON ZOOK
Credential	:	PT
Telephone Number	:	253-202-6858

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/29/2010

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Directions to “OPTIMUM PHYSICAL THERAPY, LLC ” Practice Location

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