Provider Demographics
NPI:1811786585
Name:OPTIMUM PHYSIOCARE LLC
Entity type:Organization
Organization Name:OPTIMUM PHYSIOCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OCO-SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-763-1909
Mailing Address - Street 1:11200 HOLTER RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-3429
Mailing Address - Country:US
Mailing Address - Phone:443-763-1909
Mailing Address - Fax:443-763-1909
Practice Address - Street 1:11200 HOLTER RD
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-3429
Practice Address - Country:US
Practice Address - Phone:443-763-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty