Provider Demographics
NPI:1831644293
Name:OPTIMAL PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OPTIMAL PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ALMA
Authorized Official - Last Name:NORVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-342-2344
Mailing Address - Street 1:PO BOX 2414
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39442-2414
Mailing Address - Country:US
Mailing Address - Phone:601-342-2344
Mailing Address - Fax:
Practice Address - Street 1:204 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440
Practice Address - Country:US
Practice Address - Phone:601-342-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty