Provider Demographics
NPI:1043079254
Name:OPT REHAB LLC
Entity Type:Organization
Organization Name:OPT REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SELVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:201-375-1391
Mailing Address - Street 1:866 BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3062
Mailing Address - Country:US
Mailing Address - Phone:201-600-9488
Mailing Address - Fax:
Practice Address - Street 1:866 BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3062
Practice Address - Country:US
Practice Address - Phone:201-600-9488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty