Provider Demographics
NPI:1255850293
Name:CENTER FOR OPTIMAL MOVEMENT
Entity Type:Organization
Organization Name:CENTER FOR OPTIMAL MOVEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-909-2355
Mailing Address - Street 1:6125 PASEO DEL NORTE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1113
Mailing Address - Country:US
Mailing Address - Phone:760-909-2355
Mailing Address - Fax:760-448-5363
Practice Address - Street 1:6125 PASEO DEL NORTE STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1113
Practice Address - Country:US
Practice Address - Phone:760-909-2355
Practice Address - Fax:760-448-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25475225100000X, 261QP2000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty