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General NPI Number Information
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NPI Number | 1649495474
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Entity Type | Organization
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Legal Business Name | OPTIMUM HEALTH CLINIC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 7 N WOLF RD
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City | PROSPECT HEIGHTS
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State | IL
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Zip | 60070-1749
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Country | US
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Telephone | 847-297-2225
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Fax | 247-297-2096
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Provider Business Mailing Address
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Address Line | 7 N WOLF RD
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City | PROSPECT HEIGHTS
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State | IL
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Zip | 60070-1749
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Country | US
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Telephone | 847-297-2225
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Fax | 247-297-2096
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DOTTI LOSIK
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Credential |
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Telephone | 847-297-2225
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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 | 070016717
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 038009253
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License Number State | IL
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