Healthcare Provider Details

I. General information

NPI: 1336482454
Provider Name (Legal Business Name): OPTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S SUNSET AVE
LITTLEFIELD TX
79339-4899
US

IV. Provider business mailing address

1506 S SUNSET AVE
LITTLEFIELD TX
79339-4899
US

V. Phone/Fax

Practice location:
  • Phone: 806-385-3746
  • Fax: 806-385-6176
Mailing address:
  • Phone: 806-385-3746
  • Fax: 806-385-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number673840000
License Number StateTX

VIII. Authorized Official

Name: MR. JOE ONOFRE
Title or Position: MEMBER
Credential:
Phone: 806-385-3746