Healthcare Provider Details

I. General information

NPI: 1578287272
Provider Name (Legal Business Name): OPTIMUM THERAPIES MENOMONIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 STOUT RD
MENOMONIE WI
54751-2959
US

IV. Provider business mailing address

517 E CLAIREMONT AVE
EAU CLAIRE WI
54701-6479
US

V. Phone/Fax

Practice location:
  • Phone: 715-233-6230
  • Fax:
Mailing address:
  • Phone: 715-855-0408
  • Fax: 715-855-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JODI DRESEN
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 715-855-0408