NPIMap

Organization Active NPI

Optimus Physical Therapy and Orthosport Specialists PLLC

  • Physical Therapist
  • Odessa, TX
National Provider Identifier
1366733172
Registry record updated Sep 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OPTIMUS PHYSICAL THERAPY AND ORTHOSPORT SPECIALISTS PLLC
Practice address
2760 N Grandview Ave
Suite a
Odessa, TX 79762-6953
Phone
(432) 934-5609
NPI assigned
Apr 27, 2011
Last updated
Sep 6, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2011

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

Authorized official

Name
Kevin Mannix, PTNPI 1306956024
Title
Owner
Phone
(432) 934-5609

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2760 N Grandview Ave
Suite a
Odessa, TX 79762-6953

Mailing address

2760 N Grandview Ave
Suite a
Odessa, TX 79762-6953

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120928000181 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2264606458 Receives reassigned benefits from 3 practitioners
Practice locations: Midland, TX; Odessa, TX

National Provider Directory

National Provider Directory

Locations

1717 Precinct Line Rd
Ste 204
Hurst, TX 76054
Phone (817) 479-7263

2760 N Grandview Ave
Ste A
Odessa, TX 79762
Phone (432) 552-7034

6010 E Highway 191
Ste 125B
Odessa, TX 79762
Phone (432) 552-7034

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1303862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1366733172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 N GRANDVIEW AVE",
            "address_2": "SUITE A",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797626953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 N GRANDVIEW AVE",
            "address_2": "SUITE A",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797626953",
            "telephone_number": "432-934-5609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUS PHYSICAL THERAPY AND ORTHOSPORT SPECIALISTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-27",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "MANNIX",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "432-934-5609",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; 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.