Provider Demographics
NPI:1952792384
Name:OPTIMAL PERFORMANCE INC
Entity type:Organization
Organization Name:OPTIMAL PERFORMANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:READ
Authorized Official - Last Name:LARRABEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:865-804-4923
Mailing Address - Street 1:1109 APRIL DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8121
Mailing Address - Country:US
Mailing Address - Phone:865-804-4923
Mailing Address - Fax:865-558-1474
Practice Address - Street 1:200 CENTER PARK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2104
Practice Address - Country:US
Practice Address - Phone:865-804-4923
Practice Address - Fax:865-558-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty