Provider Demographics
NPI:1609946185
Name:OPTIMAL REHAB ABILITIES, INC
Entity Type:Organization
Organization Name:OPTIMAL REHAB ABILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:559-897-5270
Mailing Address - Street 1:1581 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2204
Mailing Address - Country:US
Mailing Address - Phone:559-897-5270
Mailing Address - Fax:559-897-0920
Practice Address - Street 1:1581 18TH AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2204
Practice Address - Country:US
Practice Address - Phone:559-897-5270
Practice Address - Fax:559-897-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35242251X0800X
CAOT989469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06402ZOtherBLUE SHIELD PT GRP ID#
CAZZZ06403ZOtherBLUE SHIELD OT GRP ID3
CAZZZ06402ZOtherBLUE SHIELD PT GRP ID#