Healthcare Provider Details

I. General information

NPI: 1487242228
Provider Name (Legal Business Name): AGILITAS USA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 OLIVIA DR
HERNANDO MS
38632-2053
US

IV. Provider business mailing address

PO BOX 306393
NASHVILLE TN
37230-6393
US

V. Phone/Fax

Practice location:
  • Phone: 662-298-1990
  • Fax: 662-580-4780
Mailing address:
  • Phone: 615-373-1350
  • 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: LANGE ANDREW
Title or Position: CFO
Credential:
Phone: 615-373-1350