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General NPI Number Information
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NPI Number | 1285273383
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Entity Type | Organization
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Legal Business Name | OPTIMAL LIFE HOME THERAPY, LLC
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 516 GARDEN WAY
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City | EDGEWOOD
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State | KY
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Zip | 41017-3387
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Country | US
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Telephone | 941-894-2956
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Fax |
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Provider Business Mailing Address
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Address Line | 516 GARDEN WAY
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City | EDGEWOOD
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State | KY
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Zip | 41017-3387
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Country | US
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Telephone | 941-894-2956
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/ OWNER
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Name | AMANDA MCHARGUE
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Credential | PT
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Telephone | 941-894-2956
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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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