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General NPI Number Information
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NPI Number | 1952703282
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Entity Type | Organization
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Legal Business Name | OPTIMAL MOVEMENT PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 312 BROOKSIDE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4608
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Country | US
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Telephone | 909-335-7402
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Fax |
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Provider Business Mailing Address
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Address Line | 312 BROOKSIDE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4608
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Country | US
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Telephone | 909-335-7402
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALAN ELDRIDGE
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Credential | DPT, OCS
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Telephone | 424-214-9088
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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 | 37366
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License Number State | CA
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