Basic Information
Provider Information
NPI: 1619107646
EntityType: 2
ReplacementNPI:  
OrganizationName: ATG REHAB SPECIALISTS, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: NUMOTION
OtherOrganizationType: 3
OtherLastName:  
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OtherLastNameType:  
Mailing Information
Address1: 2070 LITTLE HILLS EXPY
Address2:  
City: SAINT CHARLES
State: MO
PostalCode: 633013708
CountryCode: US
TelephoneNumber: 3144477500
FaxNumber:  
Practice Location
Address1: 6826 W PERSHING AVE
Address2: UNIT A
City: VISALIA
State: CA
PostalCode: 932918615
CountryCode: US
TelephoneNumber: 5596512324
FaxNumber: 5596512553
Other Information
ProviderEnumerationDate: 07/24/2009
LastUpdateDate: 07/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FEITEL
AuthorizedOfficialFirstName: TAMAS
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 8602573443
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332BC3200X  Y SuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment

No ID Information.


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