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General NPI Number Information
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NPI Number | 1952184699
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Entity Type | Organization
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Legal Business Name | OPTIMIZE PHYSICAL THERAPY AND WELLNESS, LLC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 10 OLDE FORGE DR
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City | SAINT CHARLES
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State | MO
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Zip | 63301-1528
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Country | US
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Telephone | 314-626-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 142 DIEKAMP LN
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City | SAINT CHARLES
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State | MO
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Zip | 63303-5137
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Country | US
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Telephone | 636-358-9612
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST - CO-OWNER
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Name | SAMANTHA DOMALEWSKI
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Credential | DPT
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Telephone | 314-626-3425
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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 |
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License Number State |
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