NPIMap

Organization Active NPI

Optimal Physical Therapy, LLC

  • Physical Therapist
  • Lake Mills, WI
National Provider Identifier
1508887464
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OPTIMAL PHYSICAL THERAPY, LLC
Practice address
805 Elm St
Lake Mills, WI 53551-1127
Phone
(920) 648-2400
Fax
(920) 648-2444
NPI assigned
Jul 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

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

Authorized official

Name
Julie Larson
Title
Office Manger
Phone
(920) 648-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X WI Primary

Addresses

Primary practice location

805 Elm St
Lake Mills, WI 53551-1127

Mailing address

805 Elm St
Lake Mills, WI 53551-1127
Phone (920) 648-2400

Other identifiers 1

IdentifierTypeStateIssuer
40431100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051102000553 WI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6608894290 Receives reassigned benefits from 8 practitioners
Practice locations: Lake Mills, WI
O20210104000584 WI DME Supplier - Independently-Practicing Physical Therapist 6608894290 Practice locations: Lake Mills, WI

National Provider Directory

National Provider Directory

Locations

809 N Main St
#B
Lake Mills, WI 53551
Phone (920) 648-2400

368 E Tyranena Park Rd
Lake Mills, WI 53551
Phone (920) 648-2400

805 Elm St
Lake Mills, WI 53551
Phone (920) 648-2400

Practitioners 8

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": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761177600000",
    "number": "1508887464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 ELM ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511127",
            "telephone_number": "920-648-2400",
            "fax_number": "920-648-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 ELM ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511127",
            "telephone_number": "920-648-2400",
            "fax_number": "920-648-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OFFICE MANGER",
        "authorized_official_telephone_number": "920-648-2400"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40431100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mills, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2025; 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.