Provider Demographics
NPI:1619605094
Name:OPTIMAL PAIN AND WELLNESS
Entity Type:Organization
Organization Name:OPTIMAL PAIN AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-301-2565
Mailing Address - Street 1:1708 E JOYCE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5251
Mailing Address - Country:US
Mailing Address - Phone:479-301-2565
Mailing Address - Fax:479-301-2717
Practice Address - Street 1:2925 ALMA HWY STE C2
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5063
Practice Address - Country:US
Practice Address - Phone:479-301-2565
Practice Address - Fax:479-301-2717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMAL PAIN AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty