Healthcare Provider Details

I. General information

NPI: 1497100358
Provider Name (Legal Business Name): OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES OLDSMAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CURLEW RD SUITE 102
OLDSMAR FL
34677-2629
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 813-343-4840
  • Fax: 866-277-6214
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