MEDICARE: OPTIMA THE CENTER FOR SPINE REHABILITATION

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	225100000X	Physical Therapist	11645	CO
2	111NR0400X	Rehabilitation Chiropractor	3773	CO
3	2255A2300X	Athletic Trainer	AT.00013932	CO
4	111NR0400X	Rehabilitation Chiropractor
5	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1407829484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMA THE CENTER FOR SPINE REHABILITATION

Provider Business Mailing Address
First Line	:	3920 N UNION BLVD STE 160
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4907
Country	:	US
Telephone Number	:	719-634-4754
Fax Number	:	719-471-3734

Provider Business Practice Location Address
First Line	:	3920 N. UNION BLVD
Second Line	:	SUITE 160
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4907
Country	:	US
Telephone Number	:	719-634-4754
Fax Number	:	719-471-3734

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	VANESSA MOAR
Credential	:
Telephone Number	:	719-632-4754

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	11/03/2025

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Directions to “OPTIMA THE CENTER FOR SPINE REHABILITATION ” Practice Location

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