Provider Demographics
NPI:1891335741
Name:OPTIMUS REHAB LLC
Entity Type:Organization
Organization Name:OPTIMUS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PT
Authorized Official - Prefix:
Authorized Official - First Name:ENGELBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DE VERA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-248-2004
Mailing Address - Street 1:PO BOX 61160
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1160
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:361-857-0572
Practice Address - Street 1:5113 SPRING BROOK DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5629
Practice Address - Country:US
Practice Address - Phone:361-248-2004
Practice Address - Fax:888-499-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
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
TX1125821OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS