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	:	1386232361
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	:	615-373-7116

Provider Business Practice Location Address
First Line	:	3879 W ASHLEY CIR UNIT 700
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-9272
Country	:	US
Telephone Number	:	843-628-0121
Fax Number	:	843-628-0124

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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