Provider Demographics
NPI:1073183018
Name:OPTIMA THERAPY MN LCC
Entity type:Organization
Organization Name:OPTIMA THERAPY MN LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDISALAM
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-203-4555
Mailing Address - Street 1:2520 E HENNEPIN AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2912
Mailing Address - Country:US
Mailing Address - Phone:612-203-4555
Mailing Address - Fax:
Practice Address - Street 1:2520 E HENNEPIN AVE UNIT D
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2912
Practice Address - Country:US
Practice Address - Phone:612-203-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency