Provider Demographics
NPI:1437468741
Name:OPTIMAL PHYSICAL THERAPY AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:OPTIMAL PHYSICAL THERAPY AND REHABILITATION, LLC
Other - Org Name:OPTIMAL REHABILITATION SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HADASSA
Authorized Official - Middle Name:GABRIELL-MARIE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:412-977-0933
Mailing Address - Street 1:1738 ELTON RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1725
Mailing Address - Country:US
Mailing Address - Phone:301-434-1980
Mailing Address - Fax:301-312-6948
Practice Address - Street 1:1738 ELTON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1725
Practice Address - Country:US
Practice Address - Phone:412-977-0933
Practice Address - Fax:301-312-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD021494E71Medicare PIN