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General NPI Number Information
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NPI Number | 1336709369
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Entity Type | Organization
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Legal Business Name | OPTIMAL PERFORMANCE & PHYSICAL THERAPIES WINTER HAVEN, LLC
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 12/24/2019
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Provider Practice Location Address
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Address Line | 5535 CYPRESS GARDENS BLVD STE 260
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City | WINTER HAVEN
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State | FL
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Zip | 33884-2241
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Country | US
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Telephone | 727-475-5540
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Fax |
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Provider Business Mailing Address
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Address Line | 21756 STATE ROAD 54 STE 102
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City | LUTZ
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State | FL
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Zip | 33549-2905
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Country | US
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Telephone | 727-475-5540
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER/OWNER
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Name | BETH PATTERSON
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Credential | PT
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Telephone | 813-690-4414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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