NPIMap

Organization Active NPI

Optimal Performance and Physical Therapies-Clearwater, LLC

  • Physical Therapist
  • Clearwater, FL
National Provider Identifier
1104283910
Registry record updated Feb 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4616 Issued in FL
Legal business name
OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES-CLEARWATER, LLC
Practice address
612 Druid Rd E
Suite D
Clearwater, FL 33756-3912
Phone
(727) 475-5543
NPI assigned
Jan 25, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2016

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

Authorized official

Name
Robert Patterson
Title
Manager
Phone
(813) 690-4494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT4616 FL Primary

Addresses

Primary practice location

612 Druid Rd E
Suite D
Clearwater, FL 33756-3912

Mailing address

6023 Hammock Woods Dr
Odessa, FL 33556-3330

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160330002223 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7416254834 Receives reassigned benefits from 9 practitioners
Practice locations: Clearwater, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456444800000",
    "number": "1104283910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6023 HAMMOCK WOODS DR",
            "city": "ODESSA",
            "state": "FL",
            "postal_code": "335563330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 DRUID RD E",
            "address_2": "SUITE D",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563912",
            "telephone_number": "727-475-5543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES-CLEARWATER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-25",
        "last_updated": "2016-02-26",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-690-4494"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT4616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; 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.