Provider Demographics
NPI:1942211669
Name:OPTIMAL REHAB ABILITIES, INC.
Entity Type:Organization
Organization Name:OPTIMAL REHAB ABILITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:559-261-4100
Mailing Address - Street 1:7405 N CEDAR AVE
Mailing Address - Street 2:#103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3838
Mailing Address - Country:US
Mailing Address - Phone:559-261-4100
Mailing Address - Fax:559-261-4101
Practice Address - Street 1:7405 N CEDAR AVE
Practice Address - Street 2:#103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3838
Practice Address - Country:US
Practice Address - Phone:559-261-4100
Practice Address - Fax:559-261-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT171682251X0800X
CAOT6214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA132158288OtherACS OWCP PROV. #
CA132158288OtherACS OWCP PROV. #