Provider Demographics
NPI:1497100358
Name:OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES OLDSMAR, LLC
Entity Type:Organization
Organization Name:OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES OLDSMAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-690-4414
Mailing Address - Street 1:21756 STATE ROAD 54 STE 102
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-2905
Mailing Address - Country:US
Mailing Address - Phone:727-475-5540
Mailing Address - Fax:844-927-4950
Practice Address - Street 1:3180 CURLEW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2629
Practice Address - Country:US
Practice Address - Phone:813-343-4840
Practice Address - Fax:866-277-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty