Provider Demographics
NPI:1508859893
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:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHOENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT ATC
Authorized Official - Phone:904-292-0195
Mailing Address - Street 1:12421 SAN JOSE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2680
Mailing Address - Country:US
Mailing Address - Phone:904-292-0195
Mailing Address - Fax:904-292-0566
Practice Address - Street 1:12421 SAN JOSE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2680
Practice Address - Country:US
Practice Address - Phone:904-292-0195
Practice Address - Fax:904-292-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7865018OtherAETNA
1699778001OtherCIGNA
7865018OtherAETNA
=========OtherTRICARE