Healthcare Provider Details

I. General information

NPI: 1538630801
Provider Name (Legal Business Name): OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES BAYSIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 N PARK PLACE BLVD STE 102
CLEARWATER FL
33759-3917
US

IV. Provider business mailing address

6023 HAMMOCK WOODS DR
ODESSA FL
33556-3330
US

V. Phone/Fax

Practice location:
  • Phone: 727-475-5540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BETH PATTERSON
Title or Position: OWNER
Credential: PT
Phone: 727-475-5540