Provider Demographics
NPI:1184214546
Name:ATLAS PHYSICAL THERAPY & SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:ATLAS PHYSICAL THERAPY & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-292-0195
Mailing Address - Street 1:12421 SAN JOSE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8662
Mailing Address - Country:US
Mailing Address - Phone:904-292-0195
Mailing Address - Fax:904-292-0566
Practice Address - Street 1:110 CUMBERLAND PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8902
Practice Address - Country:US
Practice Address - Phone:904-292-0195
Practice Address - Fax:904-292-0566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLAS PHYSICAL THERAPY & SPORTS MEDICINE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty