Basic Information
| Provider Information | |||||||||
| NPI: | 1366812331 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLAS PHYSICAL THERAPY & ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1406 CRAIN HWY S | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210614058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107622124 | ||||||||
| FaxNumber: | 4107055057 | ||||||||
| Practice Location | |||||||||
| Address1: | 1406 CRAIN HWY S | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210614058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107622124 | ||||||||
| FaxNumber: | 4107055057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2015 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | SANNER | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | TABELLION | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4107622124 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 22199 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.