Provider Demographics
NPI:1639840812
Name:ATLAS PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ATLAS PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:ATLAS PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:THERIOT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:504-891-3330
Mailing Address - Street 1:5201 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1845
Mailing Address - Country:US
Mailing Address - Phone:504-891-3330
Mailing Address - Fax:
Practice Address - Street 1:5201 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-1845
Practice Address - Country:US
Practice Address - Phone:985-791-4497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty