MEDICARE: ALAN ATOGAMIS DE SOUZA PT

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	225700000X	Massage Therapist	MT012759	GA
2	225100000X	Physical Therapist	PT39673	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA99739	OTHER	FL	MEDICAL LICENSE
2	PT39673	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1437764313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN ATOGAMIS DE SOUZA PT

Provider Business Mailing Address
First Line	:	1656 WILKINSON WAY SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-1604
Country	:	US
Telephone Number	:	206-566-1078
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N SEMORAN BLVD STE 101
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3381
Country	:	US
Telephone Number	:	407-815-6555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	12/22/2022

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Directions to “ ALAN ATOGAMIS DE SOUZA PT” Practice Location

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