Provider Demographics
NPI:1801624853
Name:OPTITUNE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:OPTITUNE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DE PROOST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-819-7207
Mailing Address - Street 1:3880 CROISAN CREEK RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9412
Mailing Address - Country:US
Mailing Address - Phone:505-819-7207
Mailing Address - Fax:
Practice Address - Street 1:528 COTTAGE ST NE STE 203
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3787
Practice Address - Country:US
Practice Address - Phone:505-819-7207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy