Provider Demographics
NPI:1215936919
Name:OPTIMAL PHYSICAL THERAPY AND SPORTS PERFORMANCE LLC
Entity type:Organization
Organization Name:OPTIMAL PHYSICAL THERAPY AND SPORTS PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:SHEEHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-779-1300
Mailing Address - Street 1:213 EXECUTIVE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6442
Mailing Address - Country:US
Mailing Address - Phone:724-779-1300
Mailing Address - Fax:724-779-1310
Practice Address - Street 1:213 EXECUTIVE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6442
Practice Address - Country:US
Practice Address - Phone:724-779-1300
Practice Address - Fax:724-779-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X81012Medicare UPIN
PA064284Medicare ID - Type Unspecified