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General NPI Number Information
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NPI Number | 1548565815
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Entity Type | Organization
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Legal Business Name | ATHLETIC CONSULTING GROUP, INC.
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 4472 MCASHTON ST
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City | SARASOTA
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State | FL
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Zip | 34233-2200
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Country | US
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Telephone | 941-349-4453
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Fax | 941-924-7402
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Provider Business Mailing Address
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Address Line | PO BOX 18656
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City | SARASOTA
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State | FL
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Zip | 34276-1656
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Country | US
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Telephone | 941-349-4453
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Fax | 941-924-7402
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW THEODORE BABIAK
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Credential | P.T.
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Telephone | 941-349-4453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2510
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License Number State | FL
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