Provider Demographics
NPI:1760208557
Name:ATLAS PHYSICAL FITNESS
Entity type:Organization
Organization Name:ATLAS PHYSICAL FITNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGNONI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:352-205-6147
Mailing Address - Street 1:1011 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6741
Mailing Address - Country:US
Mailing Address - Phone:352-205-6147
Mailing Address - Fax:
Practice Address - Street 1:854 S DUNCAN DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4044
Practice Address - Country:US
Practice Address - Phone:352-205-6147
Practice Address - Fax:352-306-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy