MEDICARE: OPTIMAL PATIENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1275921777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL PATIENT CARE LLC

Provider Business Mailing Address
First Line	:	4319 E 7TH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-4628
Country	:	US
Telephone Number	:	813-961-8262
Fax Number	:	813-961-8264

Provider Business Practice Location Address
First Line	:	8225 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3016
Country	:	US
Telephone Number	:	727-372-5206
Fax Number	:	727-372-8474

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FERMIN BACALSO ROTEA
Credential	:	PT
Telephone Number	:	813-310-1526

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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