Provider Demographics
NPI:1982281515
Name:OPTIMAL MOVEMENT PT
Entity Type:Organization
Organization Name:OPTIMAL MOVEMENT PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,COMT
Authorized Official - Phone:201-835-4343
Mailing Address - Street 1:4 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-1315
Mailing Address - Country:US
Mailing Address - Phone:201-835-4343
Mailing Address - Fax:
Practice Address - Street 1:142 ROUTE 23
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-2000
Practice Address - Country:US
Practice Address - Phone:201-835-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-28
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty