Provider Demographics
NPI:1861277626
Name:OPTIMIZE PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:OPTIMIZE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLANDSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-308-8100
Mailing Address - Street 1:10 OLDE FORGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1528
Mailing Address - Country:US
Mailing Address - Phone:314-308-8100
Mailing Address - Fax:
Practice Address - Street 1:10 OLDE FORGE DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1528
Practice Address - Country:US
Practice Address - Phone:314-308-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy