Organization
OPTIMUM REHAB & SPORTS TRAINING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK DUFAULT PT (OWNER/PHYSICAL THERAPIST)
(919) 667-4873
Entity
Organization
Contact information
Practice address
6405 WESTGATE RD, SUITE 105, RALEIGH, NC 27617-4757
(919) 508-6835
Mailing address
6405 WESTGATE RD, SUITE 105, RALEIGH, NC 27617-4757
(919) 508-6835
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
P6231
NC
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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