Provider Demographics
NPI:1902825078
Name:OPTIMAL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OPTIMAL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TAMERIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:301-855-6326
Mailing Address - Street 1:10020 SOUTHERN MARYLAND BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3036
Mailing Address - Country:US
Mailing Address - Phone:301-855-6326
Mailing Address - Fax:301-855-6328
Practice Address - Street 1:10020 SOUTHERN MARYLAND BLVD STE 103
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3036
Practice Address - Country:US
Practice Address - Phone:301-855-6326
Practice Address - Fax:301-855-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD743BOPOtherBCBS MD PROVIDER NUMBER
MDK4980001OtherBCBS DC PROVIDER NUMBER
MD3128965OtherOPTIMUM CHOICE PROVIDER
MD45519OtherINJURED WORKERS INS FUND
MD743BOPOtherBCBS MD PROVIDER NUMBER