Healthcare Provider Details

I. General information

NPI: 1063816940
Provider Name (Legal Business Name): ATLAS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 11/18/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIANA CT STE A
PADUCAH KY
42001-6787
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-4912
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-0681
  • Fax: 270-442-7948
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA STREETER
Title or Position: VICE PRESIDENT
Credential:
Phone: 800-699-9395