Provider Demographics
NPI:1366812331
Name:ATLAS PHYSICAL THERAPY & ASSOCIATES, LLC
Entity type:Organization
Organization Name:ATLAS PHYSICAL THERAPY & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:TABELLION
Authorized Official - Last Name:SANNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:410-762-2124
Mailing Address - Street 1:1406 CRAIN HWY S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4058
Mailing Address - Country:US
Mailing Address - Phone:410-762-2124
Mailing Address - Fax:410-705-5057
Practice Address - Street 1:1406 CRAIN HWY S
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4058
Practice Address - Country:US
Practice Address - Phone:410-762-2124
Practice Address - Fax:410-705-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22199261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy