Provider Demographics
NPI:1659562023
Name:OPTIMAL CARE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:OPTIMAL CARE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRICIA ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:631-689-6666
Mailing Address - Street 1:215 HALLOCK ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-689-6666
Mailing Address - Fax:631-689-6668
Practice Address - Street 1:215 HALLOCK ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-689-6666
Practice Address - Fax:631-689-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WXW1OtherMEDICARE