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General NPI Number Information
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NPI Number | 1568641330
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Entity Type | Organization
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Legal Business Name | OPTIMUM SPORTS AND SPINAL REHABILITATION, LTD.
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 101 SCHELTER RD SUITE B 101
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3644
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Country | US
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Telephone | 847-821-1300
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Fax | 847-821-1331
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Provider Business Mailing Address
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Address Line | 101 SCHELTER RD SUITE B 101
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3644
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Country | US
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Telephone | 847-821-1300
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Fax | 847-821-1331
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MARC SING
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Credential | D.C.
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Telephone | 847-821-1300
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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 | 042.618640
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License Number State | IL
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