Provider Demographics
NPI:1740449081
Name:OPTIMUM PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:OPTIMUM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRUPTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-870-5967
Mailing Address - Street 1:1911 KENNEDY DR
Mailing Address - Street 2:203
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4779
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6940 BRADDOCK RD
Practice Address - Street 2:A
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6036
Practice Address - Country:US
Practice Address - Phone:703-870-5967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty