| Organization Name: | OPTIMUM WELLNESS AND REHABILITATION PC |
| NPI Number: | 1861540239 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD C COY (PRESIDENT) |
| Mailing Address: | 3407 S State Route 157 Glen Carbon |
| State: | IL US |
| Postal Code: | 620341042 |
| Phone Number: | 6182883610 |
| Fax Number: | |
| NPI Enumeration Date: | 01/08/2007 |
| NPI Last Update Date: | 04/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070-006607 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |