Provider Demographics
NPI:1740790328
Name:OPTIMUM HEALTH AND PERFORMANCE, LLC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH AND PERFORMANCE, LLC
Other - Org Name:PREMIER HEALTH AND PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-369-0320
Mailing Address - Street 1:301 OXFORD VALLEY RD STE 1601A
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD STE 1601A
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7721
Practice Address - Country:US
Practice Address - Phone:215-369-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMUM HEALTH AND PERFORMANCE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-09
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty