Basic Information
Provider Information
NPI: 1699411553
EntityType: 2
ReplacementNPI:  
OrganizationName: OPTIMAL HEALTH PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8874 KINGSTON PIKE STE 100
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379235025
CountryCode: US
TelephoneNumber: 8656919055
FaxNumber: 8655319018
Practice Location
Address1: 2905 TAZEWELL PIKE
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379181874
CountryCode: US
TelephoneNumber: 8656861600
FaxNumber: 8656863380
Other Information
ProviderEnumerationDate: 05/12/2022
LastUpdateDate: 07/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HUMPHREY
AuthorizedOfficialFirstName: CATHY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: COMPLIANCE OFFICER
AuthorizedOfficialTelephone: 8656919055
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


Home