Healthcare Provider Details

I. General information

NPI: 1487832465
Provider Name (Legal Business Name): OPTIMUM PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13906 GOLD CIR SUITE 103
OMAHA NE
68144-2335
US

IV. Provider business mailing address

PO BOX 45502
OMAHA NE
68145-0502
US

V. Phone/Fax

Practice location:
  • Phone: 402-639-6708
  • Fax: 402-614-4730
Mailing address:
  • Phone: 402-639-6708
  • Fax: 402-614-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CASANDRA MARIE BAKER
Title or Position: OWNER-THERAPIST
Credential: P.T., O.C.S
Phone: 402-639-6708