Provider Demographics
NPI:1457024309
Name:ATOMIC SPORTS PHYSIO AND PERFORMANCE LLC
Entity Type:Organization
Organization Name:ATOMIC SPORTS PHYSIO AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-350-2288
Mailing Address - Street 1:3510 CORDGRASS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-9253
Mailing Address - Country:US
Mailing Address - Phone:703-350-2288
Mailing Address - Fax:
Practice Address - Street 1:3510 CORDGRASS DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-9253
Practice Address - Country:US
Practice Address - Phone:703-350-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty