NPIMap

Organization Active NPI

Optimal Physical Therapy Gym LLC

  • Physical Therapist
  • Philadelphia, PA
National Provider Identifier
1386964773
Registry record updated Feb 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015725 Issued in PA
Legal business name
OPTIMAL PHYSICAL THERAPY GYM LLC
Practice address
600 Washington Ave
Suite 18U-a
Philadelphia, PA 19147-4836
Phone
(215) 678-4620
Fax
(215) 701-2254
NPI assigned
Jun 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2014

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

Authorized official

Name
Mr. Jeffery Randle Coles Jr., MPTNPI 1508188707
Title
Physical Therapist
Phone
(267) 475-2458

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT015725 PA Primary

Addresses

Primary practice location

600 Washington Ave
Suite 18U-a
Philadelphia, PA 19147-4836

Mailing address

600 Washington Ave
Suite 18U-a
Philadelphia, PA 19147-4836
Phone (215) 678-4620

Other identifiers 1

IdentifierTypeStateIssuer
102601450-0001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101220000861 PA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7517155468 Receives reassigned benefits from 3 practitioners
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Tax ID family
Optimal Physical Therapy Gym2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1105 E Passyunk Ave
Philadelphia, PA 19147
Phone (215) 678-4620

1400 Englewood St
Philadelphia, PA 19111
Phone (215) 678-4620

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393459200000",
    "number": "1386964773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WASHINGTON AVE",
            "address_2": "SUITE 18U-A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191474836",
            "telephone_number": "215-678-4620",
            "fax_number": "215-701-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WASHINGTON AVE",
            "address_2": "SUITE 18U-A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191474836",
            "telephone_number": "215-678-4620",
            "fax_number": "215-701-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PHYSICAL THERAPY GYM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-08",
        "last_updated": "2014-02-27",
        "status": "A",
        "authorized_official_last_name": "COLES",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "RANDLE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "267-475-2458",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT015725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102601450-0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.