Provider Demographics
NPI:1114998523
Name:OPTIMUM THERAPY MISSION
Entity Type:Organization
Organization Name:OPTIMUM THERAPY MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPEIGHTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-424-7885
Mailing Address - Street 1:PO BOX 720855
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0855
Mailing Address - Country:US
Mailing Address - Phone:956-424-7885
Mailing Address - Fax:956-424-7811
Practice Address - Street 1:1022 E GRIFFIN PARKWAY STE 203
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2402
Practice Address - Country:US
Practice Address - Phone:956-424-7885
Practice Address - Fax:956-424-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656260000225100000X
TX1087971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1699746Medicaid
TX00784WMedicare PIN