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General NPI Number Information
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NPI Number | 1710769989
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Entity Type | Organization
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Legal Business Name | OPTIMAL PERFORMANCE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 11444 E CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67206-2805
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Country | US
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Telephone | 316-650-1433
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Fax | 316-215-8264
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Provider Business Mailing Address
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Address Line | 1012 N CREST ST
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City | WICHITA
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State | KS
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Zip | 67206-7204
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Country | US
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Telephone | 316-650-1433
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Fax | 316-215-8264
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Authorized Official
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Title or Position | DPT/OWNER
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Name | ZACHARIAH STUKE
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Credential | DPT
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Telephone | 316-650-1433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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