Optimize Physical Therapy and Sports Performance, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

OPTIMIZE PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC

Doing business as

Optimize Physical Therapy and Sports Performance, LLC

Practice address

3030 Powers Ave
Jacksonville, FL 32207-8043

Phone

(219) 805-1184

NPI assigned

Oct 25, 2020

Organization subpart

No

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

Authorized official

Name

Dr. John Jacob Evanich, PT, DPT, OCSNPI 1629594247

Title

President

Phone

(219) 805-1184

Specialties & licenses 1

Addresses

Other names 1

• Optimize Physical Therapy and Sports Performance, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• John Jacob Evanich, PT, DPT, ATC

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1629594247
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1603584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603584000000",
    "number": "1215536776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4941 WHITE BLUFF DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322251115",
            "telephone_number": "219-805-1184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 POWERS AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078043",
            "telephone_number": "219-805-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMIZE PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-25",
        "last_updated": "2020-10-25",
        "certification_date": "2020-10-25",
        "status": "A",
        "authorized_official_last_name": "EVANICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JACOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-805-1184",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, OCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimize Physical Therapy and Sports Performance, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapy Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2020; 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.