NPIMap

Organization Active NPI

Optimal Performance and Physical Therapies-Brandon LLC

  • Physical Therapist
  • Brandon, FL
National Provider Identifier
1407132632
Registry record updated Nov 2, 2011
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-BRANDON LLC
Practice address
1056 E Brandon Blvd
Brandon, FL 33511-5509
Phone
(813) 690-4414
NPI assigned
Nov 2, 2011
Last updated
Nov 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Authorized official

Name
Beth Ann Patterson, PT, SCSNPI 1215051776
Title
Secretay
Phone
(813) 690-4414

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 Therapist 225100000X PT4616 FL Primary

Addresses

Primary practice location

1056 E Brandon Blvd
Brandon, FL 33511-5509

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
O20120127000322 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7214104587 Receives reassigned benefits from 14 practitioners
Practice locations: Brandon, FL

National Provider Directory

National Provider Directory

Locations

1056 E Brandon Blvd
Brandon, FL 33511
Phone (813) 413-5513

1076 E Brandon Blvd
Ste 106
Brandon, FL 33511
Phone (813) 413-5513

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1407132632",
    "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": "1056 E BRANDON BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115509",
            "telephone_number": "813-690-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES-BRANDON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-02",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "SECRETAY",
        "authorized_official_telephone_number": "813-690-4414",
        "authorized_official_credential": "PT, SCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT4616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.