Provider Demographics
NPI:1205691086
Name:OPTIMAL LOADING PHYSIO LLC
Entity type:Organization
Organization Name:OPTIMAL LOADING PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/ONWER
Authorized Official - Prefix:
Authorized Official - First Name:JUNHO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-874-1565
Mailing Address - Street 1:324 RARITAN AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2758
Mailing Address - Country:US
Mailing Address - Phone:732-874-1565
Mailing Address - Fax:
Practice Address - Street 1:324 RARITAN AVE STE 114
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2758
Practice Address - Country:US
Practice Address - Phone:732-874-1565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty