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General NPI Number Information
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NPI Number | 1518363266
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Entity Type | Organization
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Legal Business Name | OPTIMUS LLC
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 8517 N DIXIE DR STE 100
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City | DAYTON
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State | OH
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Zip | 45414-6400
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Country | US
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Telephone | 937-454-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 8517 N DIXIE DR STE 100
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City | DAYTON
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State | OH
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Zip | 45414-6400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN BRANDT
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Credential | CPO
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Telephone | 937-454-1900
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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 | PT.004254
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License Number State | OH
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