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General NPI Number Information
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NPI Number | 1215071485
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Entity Type | Organization
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Legal Business Name | OPTIMUM PHYSICAL THERAPY & WELLNESS
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 34213 YUCAIPA BLVD SUITE A
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City | YUCAIPA
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State | CA
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Zip | 92399-2494
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Country | US
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Telephone | 909-797-9010
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Fax | 909-797-9046
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Provider Business Mailing Address
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Address Line | PO BOX 11955
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-1955
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Country | US
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Telephone | 909-797-9010
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Fax | 909-797-9046
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ROSA MATOS
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Credential |
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Telephone | 909-790-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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