Healthcare Provider Details

I. General information

NPI: 1114286531
Provider Name (Legal Business Name): OPTIMUM PERFORMANCE TRAINING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 SPARGER RD
DURHAM NC
27705-2227
US

IV. Provider business mailing address

2309 SPARGER RD
DURHAM NC
27705-2227
US

V. Phone/Fax

Practice location:
  • Phone: 919-382-0082
  • Fax: 919-383-9112
Mailing address:
  • Phone: 919-382-0082
  • Fax: 919-383-9112

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: MICHAEL WILLIAM BRINKMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-382-0082