Healthcare Provider Details

I. General information

NPI: 1497488043
Provider Name (Legal Business Name): PERFORMANCE OPTIMAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9128 STRADA PL STE 10115
NAPLES FL
34108-2937
US

IV. Provider business mailing address

PO BOX 402
COS COB CT
06807-0402
US

V. Phone/Fax

Practice location:
  • Phone: 203-557-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TODD WILKOWSKI
Title or Position: CEO
Credential: DPT
Phone: 203-557-4000