Provider Demographics
NPI:1972812675
Name:OPTIMUM PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:OPTIMUM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOOK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-202-6858
Mailing Address - Street 1:1027 REGENTS BLVD
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6030
Mailing Address - Country:US
Mailing Address - Phone:253-202-6858
Mailing Address - Fax:
Practice Address - Street 1:1027 REGENTS BLVD
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6030
Practice Address - Country:US
Practice Address - Phone:253-202-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008775225100000X
WAPT00009243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013956184Medicare PIN
WA1508807991Medicare PIN