=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336387646
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTIMAL HEALTH PHYSICAL THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2009
-----------------------------------------------------
Last Update Date | 01/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 864 HAYWOOD RD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-252-4422
-----------------------------------------------------
Fax | 828-252-4411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 864 HAYWOOD RD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-252-4422
-----------------------------------------------------
Fax | 828-252-4411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ADRIENNE L. KRAMER
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 828-252-4422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 6100
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------