NPIMap

Organization Active NPI

Optimum Physio

  • Physical Medicine & Rehabilitation Physician
  • San Antonio, TX
National Provider Identifier
1609294040
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
675820000 Issued in TX
Legal business name
OPTIMUM PHYSIO
Practice address
2322 San Pedro Ave
San Antonio, TX 78212
Phone
(210) 314-6725
Fax
(210) 957-8585
NPI assigned
Apr 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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

Authorized official

Name
Mrs. Sonia De Anda
Title
Administrator
Phone
(210) 314-6725

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X 675820000 TX Primary

Addresses

Primary practice location

2322 San Pedro Ave
San Antonio, TX 78212

Mailing address

2322 San Pedro Ave
San Antonio, TX 78212-3237
Phone (210) 314-6725

Other identifiers 1

IdentifierTypeStateIssuer
3516395MedicaidTX

Other names 1

  • OPTIMUM PHYSIO, LLC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140902001901 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5496973547 Receives reassigned benefits from 2 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

2322 San Pedro Ave
San Antonio, TX 78212
Phone (210) 314-6725

140 Fredericksburg Rd
#D
San Antonio, TX 78201
Phone (210) 314-6725

Practitioners & affiliated clinicians

Practitioners 7

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": "1396396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614297600000",
    "number": "1609294040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2322 SAN PEDRO AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782123237",
            "telephone_number": "210-314-6725",
            "fax_number": "210-957-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 SAN PEDRO AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78212",
            "telephone_number": "210-314-6725",
            "fax_number": "210-957-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM PHYSIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-02",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A",
        "authorized_official_last_name": "DE ANDA",
        "authorized_official_first_name": "SONIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "210-314-6725",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "675820000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3516395",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTIMUM PHYSIO, LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "OPTIMUM PHYSIO, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; 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.