Provider Demographics
NPI:1225675010
Name:OPTIMAL HEALTH PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBRA JOANNE
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:MANGIBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-579-6517
Mailing Address - Street 1:3975 56TH ST APT 2H
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8903
Mailing Address - Country:US
Mailing Address - Phone:347-579-6517
Mailing Address - Fax:
Practice Address - Street 1:17541 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5724
Practice Address - Country:US
Practice Address - Phone:347-549-6517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty