Optimum Wellness Physical Therapy LLC.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305204344 Issued in VA

Legal business name

OPTIMUM WELLNESS PHYSICAL THERAPY LLC.

Practice address

9625 Surveyor CT
Ste 200a
Manassas, VA 20110-4422

Phone

(703) 335-8275

Fax

(703) 656-4727

NPI assigned

May 19, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Marsha Tracelyn Colon, MSPT

Title

Physical Therapist

Phone

(301) 452-2168

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422921600000",
    "number": "1053604348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9625 SURVEYOR CT",
            "address_2": "STE 120",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104422",
            "telephone_number": "703-335-8275",
            "fax_number": "703-656-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9625 SURVEYOR CT",
            "address_2": "STE 200A",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104422",
            "telephone_number": "703-335-8275",
            "fax_number": "703-656-4727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM WELLNESS PHYSICAL THERAPY LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-19",
        "last_updated": "2015-02-03",
        "status": "A",
        "authorized_official_last_name": "COLON",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_middle_name": "TRACELYN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "301-452-2168",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305204344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.