Provider Demographics
NPI:1164859666
Name:OPTIMAL PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:OPTIMAL PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHISHINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-649-5339
Mailing Address - Street 1:8540 S SEPULVEDA BLVD
Mailing Address - Street 2:STE 916
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3807
Mailing Address - Country:US
Mailing Address - Phone:310-649-5339
Mailing Address - Fax:310-649-5357
Practice Address - Street 1:8540 S SEPULVEDA BLVD
Practice Address - Street 2:STE 916
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3807
Practice Address - Country:US
Practice Address - Phone:310-649-5339
Practice Address - Fax:310-649-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty