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General NPI Number Information
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NPI Number | 1366673162
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Entity Type | Organization
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Legal Business Name | OPTIMUM PERFORMANCE PHYSICAL THERAPY & TRAINING, PLLC
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 4217 MERRICK RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758-6015
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Country | US
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Telephone | 516-765-1637
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Fax | 516-977-0799
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Provider Business Mailing Address
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Address Line | 209 MONROE ST
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-2423
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Country | US
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Telephone | 516-765-1637
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Fax | 516-977-0799
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Authorized Official
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Title or Position | OWNER
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Name | MR. SCOTT RADOMSKI
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Credential | PT
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Telephone | 516-765-1637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 0183841
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License Number State | NY
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