Provider Demographics
NPI:1992494868
Name:OPTIMAL PERFORMANCE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:OPTIMAL PERFORMANCE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:O'NEAL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-648-0643
Mailing Address - Street 1:2208 FM 620 N APT 3203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2819
Mailing Address - Country:US
Mailing Address - Phone:361-648-0643
Mailing Address - Fax:
Practice Address - Street 1:2901 RANCH ROAD 620 N
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-2208
Practice Address - Country:US
Practice Address - Phone:512-815-3748
Practice Address - Fax:512-352-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy