Healthcare Provider Details

I. General information

NPI: 1902134018
Provider Name (Legal Business Name): OPTIMUM THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 DEER POINT DR
MONTGOMERY IL
60538-4051
US

IV. Provider business mailing address

2514 DEER POINT DR
MONTGOMERY IL
60538-4051
US

V. Phone/Fax

Practice location:
  • Phone: 630-706-1216
  • Fax: 630-299-4788
Mailing address:
  • Phone: 630-706-1216
  • Fax: 630-299-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARIA CHERRYL FLORESCA
Title or Position: MANAGER
Credential: PT
Phone: 630-706-1216