Provider Demographics
NPI:1740691690
Name:OPTIMUM PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:OPTIMUM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEKEIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-636-9436
Mailing Address - Street 1:19082 RH JOHNSON BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375
Mailing Address - Country:US
Mailing Address - Phone:480-636-9436
Mailing Address - Fax:
Practice Address - Street 1:19082 N R H JOHNSON BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4482
Practice Address - Country:US
Practice Address - Phone:480-636-9436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty