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General NPI Number Information
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NPI Number | 1417227224
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Entity Type | Organization
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Legal Business Name | OPTIMUM REHAB, LLC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 2022 E SMOKE TREE RD
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City | GILBERT
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State | AZ
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Zip | 85296-2757
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Country | US
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Telephone | 480-993-5672
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Fax | 480-892-2646
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Provider Business Mailing Address
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Address Line | 2022 E SMOKE TREE RD
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City | GILBERT
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State | AZ
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Zip | 85296-2757
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Country | US
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Telephone | 480-993-5672
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Fax | 480-892-2646
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Authorized Official
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Title or Position | OWNER, PTA
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Name | JANET ANN LAMOREE
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Credential | PTA, ATC
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Telephone | 480-993-5672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0900X
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Taxonomy Name | Amputee Clinic/Center
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License Number | 7918A
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License Number State | AZ
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