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NPI Code Detail

MEDICARE: OPTIMAL PERFORMANCE GROUP INC

MEDICARE: OPTIMAL PERFORMANCE GROUP INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY4386FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437362860
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTIMAL PERFORMANCE GROUP INC
Provider Business Mailing Address
First Line : 15100 HUTCHISON RD STE 106
Second Line :
City : TAMPA
State : FL
Zip : 33625-5512
Country : US
Telephone Number : 813-728-5449
Fax Number :
Provider Business Practice Location Address
First Line : 15100 HUTCHISON RD STE 106
Second Line :
City : TAMPA
State : FL
Zip : 33625-5512
Country : US
Telephone Number : 813-728-5449
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. DAVID GRABAU
Credential : PSY.D.
Telephone Number : 813-728-5449
Provider Enumeration Date : 05/08/2007
Last Update Date : 03/05/2020

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Directions to “OPTIMAL PERFORMANCE GROUP INC ” Practice Location

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