Provider Demographics
NPI:1104327717
Name:OPTIMUM REHABILITATION SPECIALISTS, INC
Entity type:Organization
Organization Name:OPTIMUM REHABILITATION SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:MICKEY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:239-694-9102
Mailing Address - Street 1:5326 BILLINGS ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-6572
Mailing Address - Country:US
Mailing Address - Phone:239-470-3578
Mailing Address - Fax:
Practice Address - Street 1:2724 5TH ST W STE A
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1574
Practice Address - Country:US
Practice Address - Phone:239-470-3578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty