Provider Demographics
NPI:1174831523
Name:OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES ST. JOES LLC
Entity Type:Organization
Organization Name:OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES ST. JOES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-690-4414
Mailing Address - Street 1:6023 HAMMOCK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3330
Mailing Address - Country:US
Mailing Address - Phone:813-690-4414
Mailing Address - Fax:
Practice Address - Street 1:2700 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6386
Practice Address - Country:US
Practice Address - Phone:813-805-8108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty