=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891413761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGILITAS USA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2022
-----------------------------------------------------
Last Update Date | 08/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 PICKWICK ST
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38372-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-984-6202
-----------------------------------------------------
Fax | 731-506-1985
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 306393
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37230-6393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-373-1350
-----------------------------------------------------
Fax | 615-373-7116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | THOMAS BRYAN BARGANIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-536-7602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------