Provider Demographics
NPI:1699248088
Name:OPTIMAL PERFORMANCE REHAB
Entity type:Organization
Organization Name:OPTIMAL PERFORMANCE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-637-9727
Mailing Address - Street 1:110 N WASHINGTON ST STE 207
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2225
Mailing Address - Country:US
Mailing Address - Phone:301-637-9727
Mailing Address - Fax:
Practice Address - Street 1:110 N WASHINGTON ST STE 207
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2225
Practice Address - Country:US
Practice Address - Phone:301-637-9727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty