Provider Demographics
NPI:1932428745
Name:OPTIMAL MOVES PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OPTIMAL MOVES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-345-9219
Mailing Address - Street 1:69 W CEDAR ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1351
Mailing Address - Country:US
Mailing Address - Phone:845-345-9219
Mailing Address - Fax:845-345-9461
Practice Address - Street 1:69 W CEDAR ST
Practice Address - Street 2:SUITE 3
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1351
Practice Address - Country:US
Practice Address - Phone:845-345-9219
Practice Address - Fax:845-345-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020119-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty