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General NPI Number Information
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NPI Number | 1417428988
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Entity Type | Organization
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Legal Business Name | OPTIMAL REHABILITATION PLLC
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 5801 S CASS AVE
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City | WESTMONT
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State | IL
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Zip | 60559-2300
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Country | US
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Telephone | 630-971-2645
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Fax |
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Provider Business Mailing Address
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Address Line | 11179 SIENA DR
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City | FRANKFORT
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State | IL
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Zip | 60423-9062
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Country | US
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Telephone | 815-546-4654
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MELISSA E.S. XENIDIS
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Credential | DO
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Telephone | 815-546-4654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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