Provider Demographics
NPI:1356587687
Name:OPTIMUM PHYSICAL THERAPY
Entity type:Organization
Organization Name:OPTIMUM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:YEE
Authorized Official - Last Name:WAKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:562-860-3662
Mailing Address - Street 1:10601 WALKER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4744
Mailing Address - Country:US
Mailing Address - Phone:714-229-3660
Mailing Address - Fax:714-229-3663
Practice Address - Street 1:10601 WALKER ST STE 200
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4744
Practice Address - Country:US
Practice Address - Phone:714-229-3660
Practice Address - Fax:714-229-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17984261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy