Healthcare Provider Details

I. General information

NPI: 1538131917
Provider Name (Legal Business Name): OPTM PHYSICAL THERAPY OF SARATOGA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12930 SARATOGA AVE STE B5
SARATOGA CA
95070-4661
US

IV. Provider business mailing address

PO BOX 1051
FRANKLIN TN
37065-1051
US

V. Phone/Fax

Practice location:
  • Phone: 408-973-7000
  • Fax: 408-973-1600
Mailing address:
  • Phone: 408-973-7000
  • Fax: 408-973-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: BOBBY ISMAIL
Title or Position: PRESIDENT
Credential:
Phone: 209-353-1988