Provider Demographics
NPI:1669658332
Name:OPTIMUM PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:OPTIMUM PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIEZL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BARDILAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:209-383-9600
Mailing Address - Street 1:450 E YOSEMITE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8429
Mailing Address - Country:US
Mailing Address - Phone:209-383-9600
Mailing Address - Fax:
Practice Address - Street 1:450 E YOSEMITE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8429
Practice Address - Country:US
Practice Address - Phone:209-383-9600
Practice Address - Fax:209-720-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-12
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty