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General NPI Number Information
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NPI Number | 1437764313
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Entity Type | Individual
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Provider Name | ALAN ATOGAMIS DE SOUZA PT
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Gender | Male
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 500 N SEMORAN BLVD STE 101
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City | ORLANDO
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State | FL
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Zip | 32807-3381
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Country | US
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Telephone | 407-815-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 1656 WILKINSON WAY SE
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City | SMYRNA
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State | GA
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Zip | 30080-1604
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Country | US
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Telephone | 206-566-1078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT012759
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License Number State | GA
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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 | PT39673
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License Number State | FL
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