Provider Demographics
NPI:1245323252
Name:ATLANTIS PHYSICAL THERAPY ASSOC
Entity type:Organization
Organization Name:ATLANTIS PHYSICAL THERAPY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-325-7404
Mailing Address - Street 1:3528 TORRANCE BLVD.
Mailing Address - Street 2:#100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-325-7404
Mailing Address - Fax:310-325-4971
Practice Address - Street 1:3528 TORRANCE BLVD.
Practice Address - Street 2:#100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-325-7404
Practice Address - Fax:310-325-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty