Provider Demographics
NPI:1710769989
Name:OPTIMAL PERFORMANCE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:OPTIMAL PERFORMANCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STUKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:316-650-1433
Mailing Address - Street 1:1012 N CREST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-7204
Mailing Address - Country:US
Mailing Address - Phone:316-650-1433
Mailing Address - Fax:316-215-8264
Practice Address - Street 1:11444 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2805
Practice Address - Country:US
Practice Address - Phone:316-650-1433
Practice Address - Fax:316-215-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty