Healthcare Provider Details

I. General information

NPI: 1811786585
Provider Name (Legal Business Name): OPTIMUM PHYSIOCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 HOLTER RD
WHITE MARSH MD
21162-3429
US

IV. Provider business mailing address

11200 HOLTER RD
WHITE MARSH MD
21162-3429
US

V. Phone/Fax

Practice location:
  • Phone: 443-763-1909
  • Fax:
Mailing address:
  • Phone: 443-763-1909
  • Fax: 443-763-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOAN OCO-SANTOS
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 443-763-1909