Provider Demographics
NPI:1962417444
Name:AGILITAS USA INC
Entity type:Organization
Organization Name:AGILITAS USA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-238-8923
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:2177 NORTHPOINT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-8008
Practice Address - Country:US
Practice Address - Phone:423-870-1289
Practice Address - Fax:423-877-6861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGILITAS USA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727276Medicaid
AL139699Medicaid
TN3727276Medicare PIN
GA202G706296Medicare PIN
TN4941020003Medicare NSC
AL102G656000Medicare PIN
TN4941020007Medicare NSC
MS269390Medicare PIN
TN3727276Medicaid
AL139699Medicaid
NCC590Medicare PIN