Provider Demographics
NPI:1154640027
Name:AGILITY PHYSICAL THERAPY & SPORTS PERFORMANCE, LLC
Entity Type:Organization
Organization Name:AGILITY PHYSICAL THERAPY & SPORTS PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS
Authorized Official - Phone:941-468-3800
Mailing Address - Street 1:834 PINEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7123
Mailing Address - Country:US
Mailing Address - Phone:941-484-8107
Mailing Address - Fax:941-484-5186
Practice Address - Street 1:834 PINEBROOK RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7123
Practice Address - Country:US
Practice Address - Phone:941-484-8107
Practice Address - Fax:941-484-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty