Provider Demographics
NPI:1174087787
Name:OPTIMUM PERFORMANCE AND THERAPY CLINIC, PLLC
Entity type:Organization
Organization Name:OPTIMUM PERFORMANCE AND THERAPY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-256-3587
Mailing Address - Street 1:9706 DARWAY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6810
Mailing Address - Country:US
Mailing Address - Phone:915-256-3587
Mailing Address - Fax:
Practice Address - Street 1:1400 GEORGE DIETER DR STE 180
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7656
Practice Address - Country:US
Practice Address - Phone:915-234-2991
Practice Address - Fax:844-270-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty