Provider Demographics
NPI:1245667112
Name:OPTIMAL PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:OPTIMAL PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALDRIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-718-3381
Mailing Address - Street 1:751 PARK OF COMMERCE DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3626
Mailing Address - Country:US
Mailing Address - Phone:561-300-1762
Mailing Address - Fax:954-622-9120
Practice Address - Street 1:3633 CORTEZ RD W
Practice Address - Street 2:SUITE A4
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3119
Practice Address - Country:US
Practice Address - Phone:941-718-3381
Practice Address - Fax:954-622-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty