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	:	1316610645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGILITAS USA, INC

Provider Business Mailing Address
First Line	:	PO BOX 306393
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6393
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-221-9054

Provider Business Practice Location Address
First Line	:	2059 SCENIC HWY N STE C
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-6142
Country	:	US
Telephone Number	:	470-568-2818
Fax Number	:	470-427-2480

Authorized Official
Title or Position	:	CFO
Name	:	ANDREW LANGE
Credential	:
Telephone Number	:	615-373-1350

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/18/2021

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Directions to “AGILITAS USA, INC ” Practice Location

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