Provider Demographics
NPI:1144734591
Name:OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES TRINITY LLC
Entity type:Organization
Organization Name:OPTIMAL PERFORMANCE AND PHYSICAL THERAPIES TRINITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF COMPLIANCE, PRIVACY AND SE
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-690-4414
Mailing Address - Street 1:3903 NORTHDALE BLVD STE 111W
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1853
Mailing Address - Country:US
Mailing Address - Phone:813-381-6778
Mailing Address - Fax:
Practice Address - Street 1:11157 TRINITY BLVD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:813-381-6778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty