Healthcare Provider Details

I. General information

NPI: 1356807531
Provider Name (Legal Business Name): OPTIMAL PERFORMANCE & PHYSICAL THERAPIES TYRONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 66TH ST N STE 102
ST PETERSBURG FL
33710-5510
US

IV. Provider business mailing address

3903 NORTHDALE BLVD STE 111W
TAMPA FL
33624-1853
US

V. Phone/Fax

Practice location:
  • Phone: 727-475-5540
  • Fax:
Mailing address:
  • Phone: 727-475-5540
  • 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: MANAGER
Credential: PT
Phone: 813-690-4414