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NPI Code Detail

MEDICARE: OPTIMUM THERAPY INC

MEDICARE: OPTIMUM THERAPY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT13022FL

General Provider Information

NPI Number : 1205825361
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTIMUM THERAPY INC
Provider Business Mailing Address
First Line : 3885 S FLORIDA AVE
Second Line :
City : LAKELAND
State : FL
Zip : 33813-1109
Country : US
Telephone Number : 863-648-1186
Fax Number : 863-709-1416
Provider Business Practice Location Address
First Line : 3885 S FLORIDA AVE
Second Line :
City : LAKELAND
State : FL
Zip : 33813-1109
Country : US
Telephone Number : 863-648-1186
Fax Number : 863-709-1416
Authorized Official
Title or Position : RPT ADMINISTRATOR
Name : MRS. LILIAN JOSE PAGKALIWANGAN
Credential : RPT
Telephone Number : 863-648-1186
Provider Enumeration Date : 10/20/2005
Last Update Date : 08/22/2020

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1154337590 — OPTIMUM THERAPY
Practice Location Address:
3885 S FLORIDA AVE
LAKELAND, FL
33813-1109
Practice Phone: 863-648-1186
Practice Fax: 863-409-1416

Directions to “OPTIMUM THERAPY INC ” Practice Location

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