Healthcare Provider Details

I. General information

NPI: 1427979681
Provider Name (Legal Business Name): OPTIMUS THE CENTER FOR PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 S PROVIDENCE RD STE 101
COLUMBIA MO
65203-7113
US

IV. Provider business mailing address

4115 S PROVIDENCE RD STE 101
COLUMBIA MO
65203-7113
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-8877
  • Fax:
Mailing address:
  • Phone: 573-442-8877
  • 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: MR. MASON STEVENS
Title or Position: OWNER
Credential: MS
Phone: 573-639-2441