NPIMap

Organization Active NPI

Optimal Performance and Physical Therapies-Lutz, LLC

  • Physical Therapy Clinic/Center
  • Lutz, FL
National Provider Identifier
1821429911
Registry record updated Nov 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT4616 Issued in FL
Legal business name
OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES-LUTZ, LLC
Practice address
21756 State Road 54
Suite 102
Lutz, FL 33549-2905
Phone
(813) 418-7350
NPI assigned
Nov 28, 2013
Last updated
Nov 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2013

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

Authorized official

Name
Mrs. Beth Patterson, PTNPI 1215051776
Title
Owner
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 Therapy Clinic/Center 261QP2000X PT4616 FL Primary

Addresses

Primary practice location

21756 State Road 54
Suite 102
Lutz, FL 33549-2905

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
O20140212001333 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698904746 Receives reassigned benefits from 13 practitioners
Practice locations: Lutz, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1385596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385596800000",
    "number": "1821429911",
    "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": "21756 STATE ROAD 54",
            "address_2": "SUITE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335492905",
            "telephone_number": "813-418-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES-LUTZ, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-28",
        "last_updated": "2013-11-28",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-690-4414",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT4616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2013; 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.