Provider Demographics
NPI:1568459378
Name:ATLAS PHYSICAL THERAPY & SPORTS MEDICINE
Entity Type:Organization
Organization Name:ATLAS PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:GAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, CEAS
Authorized Official - Phone:573-642-8541
Mailing Address - Street 1:401 GAYLORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251
Mailing Address - Country:US
Mailing Address - Phone:573-642-8541
Mailing Address - Fax:573-642-8500
Practice Address - Street 1:401 GAYLORD DRIVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251
Practice Address - Country:US
Practice Address - Phone:573-642-8541
Practice Address - Fax:573-642-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103206174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001769Medicare PIN