Provider Demographics
NPI:1467677070
Name:OPTIMAL PHYSICAL THERAPY AND INDUSTRIAL REHAB INC
Entity type:Organization
Organization Name:OPTIMAL PHYSICAL THERAPY AND INDUSTRIAL REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TAMERIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-855-6326
Mailing Address - Street 1:10020 SOUTHERN MARYLAND BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3031
Mailing Address - Country:US
Mailing Address - Phone:301-855-6326
Mailing Address - Fax:301-855-6328
Practice Address - Street 1:10020 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:STE 103
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3031
Practice Address - Country:US
Practice Address - Phone:301-855-6326
Practice Address - Fax:301-855-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19922261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD45519OtherIWIF PROVIDER NUMBER
MDK4980001OtherBCBS PROVIDER NUMBER
MD64468302OtherBCBS RENDING NUMBER
MD743BOPOtherBCBS PROVIDER NUMBER
MD312442OtherAMERIGROUP PROVIDER NUMBE
MD3128965OtherHMO PROVIDER NUMBER
MD608478300OtherDOL PROVIDER NUMBER
MD608478300OtherDOL PROVIDER NUMBER