Provider Demographics
NPI:1356463087
Name:OPTIMUM THERAPIES, LLC
Entity type:Organization
Organization Name:OPTIMUM THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:DRESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-607-1758
Mailing Address - Street 1:1309 STOUT RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2959
Mailing Address - Country:US
Mailing Address - Phone:715-233-6230
Mailing Address - Fax:715-233-6231
Practice Address - Street 1:1309 STOUT RD
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2959
Practice Address - Country:US
Practice Address - Phone:715-233-6230
Practice Address - Fax:715-233-6231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X, 225100000X
WI5270-024208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI86654Medicare ID - Type Unspecified