NPIMap

Organization Active NPI

Agile Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Vestavia, AL
National Provider Identifier
1154578524
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PTH3294 Issued in AL
Legal business name
AGILE PHYSICAL THERAPY, LLC
Practice address
3125 Blue Lake Dr
Vestavia, AL 35243-2333
Phone
(205) 969-7887
Fax
(205) 969-7886
NPI assigned
Aug 27, 2008
Last updated
Dec 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Lisa Cates Altamirano, PT MS CSCSNPI 1265654073
Title
Director
Phone
(205) 969-7887

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PTH3294 AL Primary

Addresses

Primary practice location

3125 Blue Lake Dr
Vestavia, AL 35243-2333

Mailing address

3125 Blue Lake Dr
Vestavia, AL 35243-2333
Phone (205) 969-7887

Other identifiers 2

IdentifierTypeStateIssuer
515-92499OtherALBLUE CROSS BLUE SHIELD OF ALABAMA
1265654073OtherALNPI - INDIVIDUAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081002000367 AL Part B Supplier - Clinic/Group Practice 7012085137 Receives reassigned benefits from 11 practitioners
Practice locations: Vestavia, AL

National Provider Directory

National Provider Directory

Locations

3419 Colonnade Pkwy
Ste 100
Birmingham, AL 35243
Phone (205) 969-7887

3125 Blue Lake Dr
Vestavia, AL 35243
Phone (205) 969-7887

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1154578524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 BLUE LAKE DR",
            "city": "VESTAVIA",
            "state": "AL",
            "postal_code": "352432333",
            "telephone_number": "205-969-7887",
            "fax_number": "205-969-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 BLUE LAKE DR",
            "city": "VESTAVIA",
            "state": "AL",
            "postal_code": "352432333",
            "telephone_number": "205-969-7887",
            "fax_number": "205-969-7886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGILE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-27",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "ALTAMIRANO",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "CATES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "205-969-7887",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT MS CSCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AL",
            "license": "PTH3294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ALABAMA",
            "identifier": "515-92499",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI - INDIVIDUAL",
            "identifier": "1265654073",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vestavia, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.