Provider Demographics
NPI:1619936663
Name:OPTIMUM REHABILITATION SPECIALISTS
Entity Type:Organization
Organization Name:OPTIMUM REHABILITATION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-285-0592
Mailing Address - Street 1:PO BOX 3576
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1005
Mailing Address - Country:US
Mailing Address - Phone:330-285-0592
Mailing Address - Fax:888-803-9101
Practice Address - Street 1:2718 LEE BLVD #C
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1537
Practice Address - Country:US
Practice Address - Phone:239-303-9100
Practice Address - Fax:239-303-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0009763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRE1OtherBCBS
FL686674OtherMEDICARE PTAN
FLRE1OtherBCBS FLORIDA
FLRB6OtherBCBS FLORIDA
FLRB6OtherBCBS FLORIDA