Healthcare Provider Details

I. General information

NPI: 1295347649
Provider Name (Legal Business Name): ATI HOLDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 ROSEWICK RD
LA PLATA MD
20646-4216
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 240-776-6900
  • Fax: 240-261-5321
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT KIRK
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 708-710-9931