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General NPI Number Information
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NPI Number | 1497488043
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Entity Type | Organization
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Legal Business Name | PERFORMANCE OPTIMAL HEALTH LLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 9128 STRADA PL STE 10115
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City | NAPLES
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State | FL
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Zip | 34108-2937
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Country | US
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Telephone | 203-557-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 402
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City | COS COB
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State | CT
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Zip | 06807-0402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TODD WILKOWSKI
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Credential | DPT
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Telephone | 203-557-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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