Healthcare Provider Details

I. General information

NPI: 1407829484
Provider Name (Legal Business Name): OPTIMA THE CENTER FOR SPINE REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 N. UNION BLVD SUITE 160
COLORADO SPRINGS CO
80907-4907
US

IV. Provider business mailing address

3920 N UNION BLVD STE 160
COLORADO SPRINGS CO
80907-4907
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-4754
  • Fax: 719-471-3734
Mailing address:
  • Phone: 719-634-4754
  • Fax: 719-471-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3773
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11645
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.00013932
License Number StateCO

VIII. Authorized Official

Name: VANESSA MOAR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 719-632-4754