MEDICARE: ATLANTIC SPORTS & REHABILITATION SERVICES, 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	261QR0400X	Rehabilitation Clinic/Center	2305004631	VA
2	225100000X	Physical Therapist	2315014631	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952363822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC SPORTS & REHABILITATION SERVICES, INC

Provider Business Mailing Address
First Line	:	1410 INCARNATION DR
Second Line	:	SUITE 101
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-5708
Country	:	US
Telephone Number	:	434-978-4915
Fax Number	:	434-978-7194

Provider Business Practice Location Address
First Line	:	1410 INCARNATION DR
Second Line	:	SUITE 101
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-5708
Country	:	US
Telephone Number	:	434-978-4915
Fax Number	:	434-978-7194

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARK W TULENKO
Credential	:	MPT OCS
Telephone Number	:	434-978-4915

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/03/2012

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Directions to “ATLANTIC SPORTS & REHABILITATION SERVICES, INC ” Practice Location

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