Provider Demographics
NPI:1679782601
Name:OPTIMUM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OPTIMUM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASANDRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:402-639-6708
Mailing Address - Street 1:PO BOX 45502
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68145-0502
Mailing Address - Country:US
Mailing Address - Phone:402-639-6708
Mailing Address - Fax:402-614-4730
Practice Address - Street 1:13906 GOLD CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2335
Practice Address - Country:US
Practice Address - Phone:402-639-6708
Practice Address - Fax:402-614-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE600261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39525OtherBCBS
NEDF0781OtherRAILROAD MEDICARE
NEF244879OtherMIDLANDS CHOICE
NE39525OtherBCBS