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General NPI Number Information
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NPI Number | 1225402639
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Entity Type | Organization
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Legal Business Name | OPTIMA PHYSICAL THERAPY SERVICES
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 808 COMMERCE BOULEVARD
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City | RIVERDALE
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State | GA
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Zip | 30296
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Country | US
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Telephone | 404-599-6567
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Fax |
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Provider Business Mailing Address
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Address Line | 808 COMMERCE BOULEVARD
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City | RIVERDALE
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State | GA
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Zip | 30296
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Country | US
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Telephone | 404-599-6567
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | SADAQA WARD
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Credential | LCSW
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Telephone | 678-613-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | CSW004266
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSW004266
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License Number State | GA
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