MEDICARE: AGILITAS USA, INC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1831739721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGILITAS USA, INC

Provider Business Mailing Address
First Line	:	800 CRESCENT CENTRE DR STE 300
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7285
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-221-9054

Provider Business Practice Location Address
First Line	:	2314 SE MILITARY DR STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3527
Country	:	US
Telephone Number	:	210-390-6694
Fax Number	:	210-446-1439

Authorized Official
Title or Position	:	CFO
Name	:	ANDREW LANGE
Credential	:
Telephone Number	:	615-373-1350

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	02/20/2020

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