Healthcare Provider Details

I. General information

NPI: 1497079388
Provider Name (Legal Business Name): OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES UNIVERSITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2010
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 E 138TH AVE STE 1
TAMPA FL
33613-3902
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 813-805-8102
  • Fax: 844-757-3729
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 Number
License Number State

VIII. Authorized Official

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