NPIMap

Organization Active NPI

Optimal Performance and Physical Therapies St. Petersburg, LLC

  • Physical Therapist
  • St Petersburg, FL
National Provider Identifier
1073085734
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES ST. PETERSBURG, LLC
Practice address
2600 Dr Martin Luther King Jr St N Ste 200B
St Petersburg, FL 33704-2744
Phone
(727) 474-5580
NPI assigned
Dec 19, 2018
Last updated
Dec 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Beth Patterson, PTNPI 1215051776
Title
Manager
Phone
(813) 690-4414

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

2600 Dr Martin Luther King Jr St N Ste 200B
St Petersburg, FL 33704-2744

Mailing address

21756 State Road 54 Ste 102
Lutz, FL 33549-2905
Phone (727) 475-5580

Other identifiers 1

IdentifierTypeStateIssuer
PT19911OtherFLPT LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200107000369 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1557699212 Receives reassigned benefits from 11 practitioners
Practice locations: St Petersburg, FL

National Provider Directory

National Provider Directory

Locations

2600 Dr Martin Luther King Jr St N
Ste 200B
St Petersburg, FL 33704
Phone (727) 202-4625

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575849600000",
    "number": "1073085734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21756 STATE ROAD 54 STE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335492905",
            "telephone_number": "727-475-5580",
            "fax_number": "844-213-8986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 DR MARTIN LUTHER KING JR ST N STE 200B",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337042744",
            "telephone_number": "727-474-5580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES ST. PETERSBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-19",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-690-4414",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT19911",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.