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General NPI Number Information
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NPI Number | 1225327851
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Entity Type | Organization
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Legal Business Name | ATLANTIC THERAPY GROUP, LLC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 6645 VINELAND RD STE 270
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City | ORLANDO
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State | FL
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Zip | 32819-7840
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Country | US
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Telephone | 407-244-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 6645 VINELAND RD STE 270
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City | ORLANDO
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State | FL
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Zip | 32819-7840
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Country | US
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Telephone | 407-244-5554
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MRS. TAMI BUTLER
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Credential | MSPT
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Telephone | 407-244-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 4284
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 19588
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License Number State | FL
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