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General NPI Number Information
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NPI Number | 1740449081
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Entity Type | Organization
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Legal Business Name | OPTIMUM PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 6940 BRADDOCK RD A
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City | ANNANDALE
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State | VA
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Zip | 22003-6036
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Country | US
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Telephone | 703-870-5967
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 KENNEDY DR 203
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City | MC LEAN
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State | VA
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Zip | 22102-4779
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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 | MANAGING MEMBER
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Name | TRUPTI PATIL
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Credential |
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Telephone | 703-870-5967
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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 |
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License Number State |
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