=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063562767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTIMUM PERFORMANCE TRAINING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 CATTLEMEN RD UNIT B
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-6312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-342-0454
-----------------------------------------------------
Fax | 941-342-0272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 CATTLEMEN RD UNIT B
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-6312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-342-0454
-----------------------------------------------------
Fax | 941-342-0272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RICHARD C LANSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-342-0454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------