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General NPI Number Information
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NPI Number | 1245667112
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Entity Type | Organization
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Legal Business Name | OPTIMAL PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 3633 CORTEZ RD W SUITE A4
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City | BRADENTON
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State | FL
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Zip | 34210-3119
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Country | US
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Telephone | 941-718-3381
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Fax | 954-622-9120
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Provider Business Mailing Address
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Address Line | 751 PARK OF COMMERCE DR SUITE 112
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City | BOCA RATON
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State | FL
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Zip | 33487-3626
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Country | US
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Telephone | 561-300-1762
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Fax | 954-622-9120
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JEREMY B WALDRIP
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Credential |
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Telephone | 941-718-3381
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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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