MEDICARE: ATLANTIC PHYSICAL THERAPY GROUP PA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1588956882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC PHYSICAL THERAPY GROUP PA LLC

Provider Business Mailing Address
First Line	:	1208 TASKER ST FL 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1019
Country	:	US
Telephone Number	:	215-271-4100
Fax Number	:	215-271-1785

Provider Business Practice Location Address
First Line	:	1208 TASKER ST FL 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1019
Country	:	US
Telephone Number	:	215-271-4100
Fax Number	:	215-271-1785

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MICHELLE FRIEDMAN
Credential	:
Telephone Number	:	215-271-4100

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	04/05/2017

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