Provider Demographics
NPI:1124626098
Name:OPTIMAL WOUND SOLUTIONS LLC
Entity type:Organization
Organization Name:OPTIMAL WOUND SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CWS
Authorized Official - Phone:808-772-0291
Mailing Address - Street 1:91-1246 KAIKOHOLA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6231
Mailing Address - Country:US
Mailing Address - Phone:808-772-0291
Mailing Address - Fax:
Practice Address - Street 1:91-1246 KAIKOHOLA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6231
Practice Address - Country:US
Practice Address - Phone:808-772-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty