Provider Demographics
NPI:1063492858
Name:OPTIMAL PHYSICAL THERAPY,LLC
Entity Type:Organization
Organization Name:OPTIMAL PHYSICAL THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:808-281-4556
Mailing Address - Street 1:PO BOX 791829
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-1829
Mailing Address - Country:US
Mailing Address - Phone:808-281-4556
Mailing Address - Fax:808-572-0113
Practice Address - Street 1:87 HOOLAI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9321
Practice Address - Country:US
Practice Address - Phone:808-281-4556
Practice Address - Fax:808-572-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53192201Medicaid
HI53192201Medicaid