Healthcare Provider Details

I. General information

NPI: 1467677070
Provider Name (Legal Business Name): OPTIMAL PHYSICAL THERAPY AND INDUSTRIAL REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 SOUTHERN MARYLAND BLVD STE 103
DUNKIRK MD
20754-3031
US

IV. Provider business mailing address

10020 SOUTHERN MARYLAND BLVD STE 103
DUNKIRK MD
20754-3031
US

V. Phone/Fax

Practice location:
  • Phone: 301-855-6326
  • Fax: 301-855-6328
Mailing address:
  • Phone: 301-855-6326
  • Fax: 301-855-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number19922
License Number StateMD

VIII. Authorized Official

Name: MRS. CAROL LYNN TAMERIS
Title or Position: PHYSICAL THERAPIST
Credential: MPT
Phone: 301-855-6326