Provider Demographics
NPI:1538104245
Name:OPTIMAL PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OPTIMAL PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARSKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:925-945-6778
Mailing Address - Street 1:801 YGNACIO VALLEY RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3871
Mailing Address - Country:US
Mailing Address - Phone:925-945-6778
Mailing Address - Fax:
Practice Address - Street 1:801 YGNACIO VALLEY RD
Practice Address - Street 2:STE. 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3871
Practice Address - Country:US
Practice Address - Phone:925-945-6778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ41873ZOtherBLUE SHIELD GROUP
CAZZZ41873ZOtherBLUE SHIELD GROUP