Provider Demographics
NPI:1427147727
Name:OPTIMUM HEALTH SPINAL REHABILITATION
Entity type:Organization
Organization Name:OPTIMUM HEALTH SPINAL REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:JUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-714-3053
Mailing Address - Street 1:4125 BUFORD DR
Mailing Address - Street 2:STE 1-B
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3459
Mailing Address - Country:US
Mailing Address - Phone:678-714-3053
Mailing Address - Fax:678-714-3063
Practice Address - Street 1:2855 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 760 318
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3563
Practice Address - Country:US
Practice Address - Phone:678-546-0550
Practice Address - Fax:678-546-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty