NPIMap

Organization Active NPI

Optimal Performance and Physical Therapies Northdale LLC

  • Physical Therapy Clinic/Center
  • Tampa, FL
National Provider Identifier
1093399347
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES NORTHDALE LLC
Practice address
6633 Gunn Highway
Tampa, FL 33625
Phone
(727) 475-5540
NPI assigned
May 11, 2021
Organization subpart
Yes
Parent organization
OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES NORTHDALE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Authorized official

Name
Beth Ann Patterson
Title
Practice Administrator
Phone
(727) 475-5540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

6633 Gunn Highway
Tampa, FL 33625

Mailing address

21756 State Road 54 Ste 102
Lutz, FL 33549-2905

Other names 1

  • Optimal Performance and Physical Therapies Citrus Park Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210928000759 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0749317709 Receives reassigned benefits from 3 practitioners
Practice locations: Tampa, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Optimal Performance and Physical Therapies Northdale LLC2 organizations share this tax ID, including this one
Part of
Optimal Performance and Physical Therapies Northdale LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3903 Northdale Blvd
Ste 111W
Tampa, FL 33624
Phone (813) 381-6778

6633 Gunn Hwy
Tampa, FL 33625
Phone (813) 519-0604

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699228800000",
    "number": "1093399347",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6633 GUNN HIGHWAY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33625",
            "telephone_number": "727-475-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES NORTHDALE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES NORTHDALE LLC",
        "enumeration_date": "2021-05-11",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "727-475-5540"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimal Performance and Physical Therapies Citrus Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; 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.