Provider Demographics
NPI:1417227224
Name:OPTIMUM REHAB, LLC
Entity Type:Organization
Organization Name:OPTIMUM REHAB, LLC
Other - Org Name:OPTIMUM REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PTA
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAMOREE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, ATC
Authorized Official - Phone:480-993-5672
Mailing Address - Street 1:2022 E SMOKE TREE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2757
Mailing Address - Country:US
Mailing Address - Phone:480-993-5672
Mailing Address - Fax:480-892-2646
Practice Address - Street 1:2022 E SMOKE TREE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2757
Practice Address - Country:US
Practice Address - Phone:480-993-5672
Practice Address - Fax:480-892-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7918A261QA0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1851547103OtherNPI