NPIMap

Organization Active NPI

Optimal Performance & Physical Therapies Tyrone, LLC

  • Physical Therapist
  • St Petersburg, FL
National Provider Identifier
1356807531
Registry record updated Feb 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OPTIMAL PERFORMANCE & PHYSICAL THERAPIES TYRONE, LLC
Practice address
1700 66TH St N Ste 102
St Petersburg, FL 33710-5510
Phone
(727) 475-5540
NPI assigned
Feb 13, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2019

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

1700 66TH St N Ste 102
St Petersburg, FL 33710-5510

Mailing address

3903 Northdale Blvd Ste 111W
Tampa, FL 33624-1853
Phone (727) 475-5540

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
O20191205000326 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6507299583 Receives reassigned benefits from 10 practitioners
Practice locations: St Petersburg, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1550016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550016000000",
    "number": "1356807531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 NORTHDALE BLVD STE 111W",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336241853",
            "telephone_number": "727-475-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 66TH ST N STE 102",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337105510",
            "telephone_number": "727-475-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PERFORMANCE & PHYSICAL THERAPIES TYRONE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-13",
        "last_updated": "2019-02-13",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "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 Feb 13, 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.