Healthcare Provider Details

I. General information

NPI: 1174831523
Provider Name (Legal Business Name): OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES ST. JOES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 10/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W DR MARTIN LUTHER KING JR BLVD SUITE 300
TAMPA FL
33607-6386
US

IV. Provider business mailing address

6023 HAMMOCK WOODS DR
ODESSA FL
33556-3330
US

V. Phone/Fax

Practice location:
  • Phone: 813-805-8108
  • Fax:
Mailing address:
  • Phone: 813-690-4414
  • 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: MRS. BETH ANN PATTERSON
Title or Position: SECRETARY
Credential: PT
Phone: 813-690-4414