Healthcare Provider Details

I. General information

NPI: 1649324450
Provider Name (Legal Business Name): OPTIMA PHYSICAL THERAPY REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 WHITE PLAINS RD
BRONX NY
10470-1610
US

IV. Provider business mailing address

PO BOX 1031
LODI NJ
07644-7031
US

V. Phone/Fax

Practice location:
  • Phone: 718-324-8166
  • Fax: 718-324-7539
Mailing address:
  • Phone: 718-324-8166
  • Fax: 718-324-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number015375
License Number StateNY

VIII. Authorized Official

Name: DR. ANTHONY AKINLOYE OLOKUNGBEMI
Title or Position: DIRECTOR
Credential: DPT
Phone: 718-324-8166