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General NPI Number Information
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NPI Number | 1891335741
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Entity Type | Organization
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Legal Business Name | OPTIMUS REHAB LLC
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 5113 SPRING BROOK DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78413-5629
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Country | US
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Telephone | 361-248-2004
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Fax | 888-499-1749
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Provider Business Mailing Address
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Address Line | PO BOX 61160
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City | CORPUS CHRISTI
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State | TX
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Zip | 78466-1160
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Country | US
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Telephone | 361-884-2904
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Fax | 361-857-0572
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Authorized Official
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Title or Position | PRESIDENT, PT
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Name | ENGELBERT DE VERA
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Credential | PT
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Telephone | 361-248-2004
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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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