Provider Demographics
NPI:1295375483
Name:OPTIMUM REHAB SOLUTIONS
Entity Type:Organization
Organization Name:OPTIMUM REHAB SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY CATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADANGUIT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-498-8412
Mailing Address - Street 1:2079 DEER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1598
Mailing Address - Country:US
Mailing Address - Phone:812-498-8412
Mailing Address - Fax:
Practice Address - Street 1:2079 DEER VALLEY CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1598
Practice Address - Country:US
Practice Address - Phone:812-498-8412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty