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General NPI Number Information
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NPI Number | 1649324450
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Entity Type | Organization
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Legal Business Name | OPTIMA PHYSICAL THERAPY REHABILITATION PC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 4626 WHITE PLAINS RD
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City | BRONX
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State | NY
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Zip | 10470-1610
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Country | US
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Telephone | 718-324-8166
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Fax | 718-324-7539
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Provider Business Mailing Address
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Address Line | PO BOX 1031
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City | LODI
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State | NJ
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Zip | 07644-7031
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Country | US
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Telephone | 718-324-8166
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Fax | 718-324-7539
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ANTHONY AKINLOYE OLOKUNGBEMI
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Credential | DPT
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Telephone | 718-324-8166
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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 | 015375
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License Number State | NY
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