Provider Demographics
NPI:1447401559
Name:OPTIMUM HEALTH & REHABILITATION INC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH & REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-767-3822
Mailing Address - Street 1:9301 GOLF RD STE 204
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1687
Mailing Address - Country:US
Mailing Address - Phone:847-391-9720
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:9301 GOLF RD STE 204
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1687
Practice Address - Country:US
Practice Address - Phone:847-391-9720
Practice Address - Fax:773-767-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1430Medicare PIN