Provider Demographics
NPI:1548950173
Name:ATLAS BRACING LLC
Entity type:Organization
Organization Name:ATLAS BRACING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-221-1161
Mailing Address - Street 1:4133 N GARTON LN
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-7102
Mailing Address - Country:US
Mailing Address - Phone:208-244-7751
Mailing Address - Fax:208-550-3256
Practice Address - Street 1:4133 N GARTON LN
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-7102
Practice Address - Country:US
Practice Address - Phone:208-244-7751
Practice Address - Fax:208-550-3256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STREAMLINE SPORTS PHYSICAL THERAPY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment