MEDICARE: AGILITAS USA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1073335535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGILITAS USA, INC

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 W MOCKINGBIRD LN STE 110
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-5205
Country	:	US
Telephone Number	:	214-556-5108
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	LAUREN HILL
Credential	:
Telephone Number	:	972-465-0296

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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