MEDICARE: OPTIMOVE PHYSICAL THERAPY & WELLNESS LLC

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
1	261QP2000X	Physical Therapy Clinic/Center	1231895	TX

General Provider Information

NPI Number	:	1376927251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMOVE PHYSICAL THERAPY & WELLNESS LLC

Provider Business Mailing Address
First Line	:	PO BOX 141136
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-1136
Country	:	US
Telephone Number	:	469-803-1838
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 GRAVEL DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-6951
Country	:	US
Telephone Number	:	469-803-1838
Fax Number	:

Authorized Official
Title or Position	:	OWNER - PHYSICAL THERAPIST
Name	:	DR. JEFFREY ROBERT GUILD
Credential	:	PT, DPT, CSCS
Telephone Number	:	469-803-1838

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	07/10/2015

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