Provider Demographics
NPI:1245655059
Name:OPTIMUM ERGO, LLC
Entity type:Organization
Organization Name:OPTIMUM ERGO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IOLANTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:CULJAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-586-1754
Mailing Address - Street 1:561 CHAPIN LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-5716
Mailing Address - Country:US
Mailing Address - Phone:970-586-1754
Mailing Address - Fax:
Practice Address - Street 1:561 CHAPIN LN UNIT 1
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-5716
Practice Address - Country:US
Practice Address - Phone:970-586-1754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO347061Medicare PIN