Healthcare Provider Details

I. General information

NPI: 1922350289
Provider Name (Legal Business Name): OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES KENDALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 SUNSET DR SUITE 111
MIAMI FL
33173-5427
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 786-507-8278
  • Fax: 844-214-1486
Mailing address:
  • Phone: 727-475-5540
  • Fax: 844-927-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4616
License Number StateFL

VIII. Authorized Official

Name: BETH PATTERSON
Title or Position: CHIEF OF COMPLIANCE
Credential:
Phone: 813-690-4414