Provider Demographics
NPI:1548565815
Name:ATHLETIC CONSULTING GROUP, INC.
Entity Type:Organization
Organization Name:ATHLETIC CONSULTING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:BABIAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-349-4453
Mailing Address - Street 1:PO BOX 18656
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34276-1656
Mailing Address - Country:US
Mailing Address - Phone:941-349-4453
Mailing Address - Fax:941-924-7402
Practice Address - Street 1:4472 MCASHTON ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2200
Practice Address - Country:US
Practice Address - Phone:941-349-4453
Practice Address - Fax:941-924-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty