Provider Demographics
NPI:1740617901
Name:ATHOMETHERAPY SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:ATHOMETHERAPY SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROQUE
Authorized Official - Middle Name:FLESTADO
Authorized Official - Last Name:ESTIPONA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:901-461-5787
Mailing Address - Street 1:3949 HERONS RETREAT CV
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8498
Mailing Address - Country:US
Mailing Address - Phone:901-461-5787
Mailing Address - Fax:
Practice Address - Street 1:856 WILLOW TREE CIR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6376
Practice Address - Country:US
Practice Address - Phone:901-794-7988
Practice Address - Fax:901-794-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4215225100000X
TN3815225100000X
TN1006225X00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty