Healthcare Provider Details

I. General information

NPI: 1891335741
Provider Name (Legal Business Name): OPTIMUS REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 SPRING BROOK DR
CORPUS CHRISTI TX
78413-5629
US

IV. Provider business mailing address

PO BOX 61160
CORPUS CHRISTI TX
78466-1160
US

V. Phone/Fax

Practice location:
  • Phone: 361-248-2004
  • Fax: 888-499-1749
Mailing address:
  • Phone: 361-884-2904
  • Fax: 361-857-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ENGELBERT DE VERA
Title or Position: PRESIDENT, PT
Credential: PT
Phone: 361-248-2004