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General NPI Number Information
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NPI Number | 1407132632
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Entity Type | Organization
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Legal Business Name | OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES-BRANDON LLC
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 1056 E BRANDON BLVD
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City | BRANDON
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State | FL
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Zip | 33511-5509
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Country | US
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Telephone | 813-690-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 6023 HAMMOCK WOODS DR
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City | ODESSA
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State | FL
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Zip | 33556-3330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETAY
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Name | BETH ANN PATTERSON
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Credential | PT, SCS
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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 | PT4616
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License Number State | FL
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