Provider Demographics
NPI:1144504986
Name:AMERICAN THERAPY GROUP INC
Entity type:Organization
Organization Name:AMERICAN THERAPY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIUVY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-225-9635
Mailing Address - Street 1:11398 W FLAGLER ST
Mailing Address - Street 2:STE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11398 W FLAGLER ST
Practice Address - Street 2:STE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4213
Practice Address - Country:US
Practice Address - Phone:305-225-9635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63681208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA63681OtherTHERAPY LICENSE