Provider Demographics
NPI:1205842986
Name:OPTIMUM PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:OPTIMUM PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SNEHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-391-9720
Mailing Address - Street 1:9301 GOLF RD
Mailing Address - Street 2:STE 204
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1667
Mailing Address - Country:US
Mailing Address - Phone:847-391-9720
Mailing Address - Fax:847-391-9721
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:STE 204
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:847-391-9720
Practice Address - Fax:847-391-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012356225100000X
IL070011869225100000X
IL056006131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL352728176001Medicaid
IL01635425OtherBC/BS PROVIDER #
IL212286Medicare PIN