Provider Demographics
NPI:1740511195
Name:OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES NORTHDALE LLC
Entity type:Organization
Organization Name:OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES NORTHDALE 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:ANN
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-690-4494
Mailing Address - Street 1:14004 ROOSEVELT BLVD STE 613
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3903 NORTHDALE BLVD
Practice Address - Street 2:SUITE 111W
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1864
Practice Address - Country:US
Practice Address - Phone:813-418-7350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty