Provider Demographics
NPI:1538131917
Name:OPTM PHYSICAL THERAPY OF SARATOGA, INC.
Entity Type:Organization
Organization Name:OPTM PHYSICAL THERAPY OF SARATOGA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-353-1988
Mailing Address - Street 1:PO BOX 1051
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-1051
Mailing Address - Country:US
Mailing Address - Phone:408-973-7000
Mailing Address - Fax:408-973-1600
Practice Address - Street 1:12930 SARATOGA AVE STE B5
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4661
Practice Address - Country:US
Practice Address - Phone:408-973-7000
Practice Address - Fax:408-973-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29721ZMedicare PIN