Provider Demographics
NPI:1114286531
Name:OPTIMUM PERFORMANCE TRAINING CENTER
Entity Type:Organization
Organization Name:OPTIMUM PERFORMANCE TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-382-0082
Mailing Address - Street 1:2309 SPARGER RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2227
Mailing Address - Country:US
Mailing Address - Phone:919-382-0082
Mailing Address - Fax:919-383-9112
Practice Address - Street 1:2309 SPARGER RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2227
Practice Address - Country:US
Practice Address - Phone:919-382-0082
Practice Address - Fax:919-383-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy