Provider Demographics
NPI:1437861705
Name:OPTIMAL FUNCTION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OPTIMAL FUNCTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:949-705-7695
Mailing Address - Street 1:22891 PLAINVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2973
Mailing Address - Country:US
Mailing Address - Phone:949-705-7695
Mailing Address - Fax:949-215-4281
Practice Address - Street 1:22891 PLAINVIEW CIR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2973
Practice Address - Country:US
Practice Address - Phone:949-705-7695
Practice Address - Fax:949-215-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT29958OtherPT LICENSE