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General NPI Number Information
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NPI Number | 1649647553
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Entity Type | Organization
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Legal Business Name | OPTIMAL PERFORMANCE PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 3435 OCEAN PARK BLVD #101
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City | SANTA MONICA
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State | CA
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Zip | 90405-3301
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Country | US
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Telephone | 310-399-0337
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Fax |
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Provider Business Mailing Address
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Address Line | 7367 HOLLYWOOD BLVD APT 302
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City | LOS ANGELES
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State | CA
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Zip | 90046-2931
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Country | US
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Telephone | 626-371-3133
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PARHAM TABLOEI
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Credential |
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Telephone | 626-371-3133
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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 | 39864
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License Number State | CA
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