Provider Demographics
NPI:1982828695
Name:ATLANTIC REHABILITATION INC
Entity Type:Organization
Organization Name:ATLANTIC REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:OTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-426-8884
Mailing Address - Street 1:5026 B NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-426-8884
Mailing Address - Fax:954-426-8885
Practice Address - Street 1:5026 B NORTH FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-426-8884
Practice Address - Fax:954-426-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12985225100000X
FLPT10149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1599Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER