MEDICARE: OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES OLDSMAR, 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	225100000X	Physical Therapist	PT4616	FL

General Provider Information

NPI Number	:	1497100358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES OLDSMAR, LLC

Provider Business Mailing Address
First Line	:	21756 STATE ROAD 54 STE 102
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-2905
Country	:	US
Telephone Number	:	727-475-5540
Fax Number	:	844-927-4950

Provider Business Practice Location Address
First Line	:	3180 CURLEW RD
Second Line	:	SUITE 102
City	:	OLDSMAR
State	:	FL
Zip	:	34677-2629
Country	:	US
Telephone Number	:	813-343-4840
Fax Number	:	866-277-6214

Authorized Official
Title or Position	:	CHIEF OF COMPLIANCE
Name	:	BETH PATTERSON
Credential	:
Telephone Number	:	813-690-4414

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	04/05/2023

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