MEDICARE: ATLANTIS AQUATICS AND REHABILITATION 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	225100000X	Physical Therapist	PT19697	FL

General Provider Information

NPI Number	:	1891842290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIS AQUATICS AND REHABILITATION INC

Provider Business Mailing Address
First Line	:	5841 S CONGRESS AVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1347
Country	:	US
Telephone Number	:	561-965-2126
Fax Number	:	561-965-2029

Provider Business Practice Location Address
First Line	:	5841 S CONGRESS AVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1347
Country	:	US
Telephone Number	:	561-965-2126
Fax Number	:	561-965-2029

Authorized Official
Title or Position	:	OFFICER
Name	:	MR. KEN MARGESON
Credential	:	PTA
Telephone Number	:	561-965-2126

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2020

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