Provider Demographics
NPI:1962894451
Name:OPTIMAL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:OPTIMAL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:307-262-7006
Mailing Address - Street 1:4120 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6104
Mailing Address - Country:US
Mailing Address - Phone:307-262-7006
Mailing Address - Fax:
Practice Address - Street 1:4120 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6104
Practice Address - Country:US
Practice Address - Phone:307-262-7006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1140261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYPT-1981OtherWYOMING STATE BOARD OF PHYSICAL THERAPY