Provider Demographics
NPI:1891842290
Name:ATLANTIS AQUATICS AND REHABILITATION INC
Entity Type:Organization
Organization Name:ATLANTIS AQUATICS AND REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGESON
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:561-965-2126
Mailing Address - Street 1:5841 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1347
Mailing Address - Country:US
Mailing Address - Phone:561-965-2126
Mailing Address - Fax:561-965-2029
Practice Address - Street 1:5841 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1347
Practice Address - Country:US
Practice Address - Phone:561-965-2126
Practice Address - Fax:561-965-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty