Healthcare Provider Details

I. General information

NPI: 1265221535
Provider Name (Legal Business Name): OPTIMIZE REHAB AND PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20309 E 23RD TER S
INDEPENDENCE MO
64057-7826
US

IV. Provider business mailing address

20309 E 23RD TER S
INDEPENDENCE MO
64057-7826
US

V. Phone/Fax

Practice location:
  • Phone: 417-860-7808
  • Fax:
Mailing address:
  • Phone: 417-860-7806
  • 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: JOSHUA AGEE
Title or Position: OWNER
Credential: DPT
Phone: 417-860-7806