Healthcare Provider Details

I. General information

NPI: 1982118345
Provider Name (Legal Business Name): ATLAS PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CLINE AVE
MANSFIELD OH
44907-1038
US

IV. Provider business mailing address

625 CLINE AVE
MANSFIELD OH
44907-1038
US

V. Phone/Fax

Practice location:
  • Phone: 419-520-9070
  • Fax: 419-520-9071
Mailing address:
  • Phone: 419-520-9070
  • Fax: 419-520-9071

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: THOMAS ZELLNER
Title or Position: OWNER
Credential:
Phone: 419-520-9070