Provider Demographics
NPI:1033598107
Name:OPTIMUM HEALTH WELLNESS AND REHAB
Entity Type:Organization
Organization Name:OPTIMUM HEALTH WELLNESS AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-471-2582
Mailing Address - Street 1:5645 CORAL RIDGE DR
Mailing Address - Street 2:SUITE 248
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3124
Mailing Address - Country:US
Mailing Address - Phone:954-471-2582
Mailing Address - Fax:
Practice Address - Street 1:5645 CORAL RIDGE DR
Practice Address - Street 2:SUITE 248
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3124
Practice Address - Country:US
Practice Address - Phone:954-471-2582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty