Provider Demographics
NPI:1841888641
Name:OPTIMUM PHYSICAL THERAPY
Entity type:Organization
Organization Name:OPTIMUM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:NWAFILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-666-2048
Mailing Address - Street 1:3425 OLD HIGHWAY 41 STE 620
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1026
Mailing Address - Country:US
Mailing Address - Phone:678-401-2793
Mailing Address - Fax:
Practice Address - Street 1:3425 OLD HIGHWAY 41 STE 620
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1026
Practice Address - Country:US
Practice Address - Phone:678-401-2793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty