Provider Demographics
NPI:1902822588
Name:OPTIMUS HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:OPTIMUS HEALTH CENTER, INC.
Other - Org Name:ST. LUKE'S THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FIORELLO ERICO
Authorized Official - Middle Name:N
Authorized Official - Last Name:PACIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:865-475-3101
Mailing Address - Street 1:657 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4906
Mailing Address - Country:US
Mailing Address - Phone:865-475-3101
Mailing Address - Fax:865-475-9213
Practice Address - Street 1:657 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4906
Practice Address - Country:US
Practice Address - Phone:865-475-3101
Practice Address - Fax:865-475-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty