Provider Demographics
NPI:1376155069
Name:ATLAS SPORTS REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:ATLAS SPORTS REHABILITATION SERVICES LLC
Other - Org Name:ATLAS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CVETKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-900-3484
Mailing Address - Street 1:10171 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8715 STIRLING RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5932
Practice Address - Country:US
Practice Address - Phone:954-900-3484
Practice Address - Fax:954-408-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty