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Organization
OPTIMAL PHYSICAL THERAPY GYM LLC
Active
Organization
OPTIMAL PHYSICAL THERAPY GYM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY RANDLE COLES JR. MPT (PHYSICAL THERAPIST)
(267) 475-2458
Entity
Organization
Contact information
Practice address
600 WASHINGTON AVE, SUITE 18U-A, PHILADELPHIA, PA 19147-4836
(215) 678-4620
(215) 701-2254
Mailing address
600 WASHINGTON AVE, SUITE 18U-A, PHILADELPHIA, PA 19147-4836
(215) 678-4620
(215) 701-2254
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT015725
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102601450-0001
—
PA
Enumeration date
06/08/2010
Last updated
02/27/2014
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