Healthcare Provider Details

I. General information

NPI: 1366360265
Provider Name (Legal Business Name): OPTIMAL SPORT AND FITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HERRINGTON DR
UPPER MARLBORO MD
20774-1545
US

IV. Provider business mailing address

77 HERRINGTON DR
UPPER MARLBORO MD
20774-1545
US

V. Phone/Fax

Practice location:
  • Phone: 240-691-8114
  • Fax:
Mailing address:
  • Phone: 240-691-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MR. OBINNA ONUEGBU
Title or Position: CEO
Credential:
Phone: 240-691-8114