Healthcare Provider Details

I. General information

NPI: 1821429911
Provider Name (Legal Business Name): OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES-LUTZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2013
Last Update Date: 11/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21756 STATE ROAD 54 SUITE 102
LUTZ FL
33549-2905
US

IV. Provider business mailing address

6023 HAMMOCK WOODS DR
ODESSA FL
33556-3330
US

V. Phone/Fax

Practice location:
  • Phone: 813-418-7350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT4616
License Number StateFL

VIII. Authorized Official

Name: MRS. BETH PATTERSON
Title or Position: OWNER
Credential: PT
Phone: 813-690-4414