NPIMap

Organization Active NPI

Atlantic Sports & Rehabilitation Services, Inc

  • Physical Therapist
  • Charlottesville, VA
National Provider Identifier
1952363822
Registry record updated Jul 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2315014631 Issued in VA
Legal business name
ATLANTIC SPORTS & REHABILITATION SERVICES, INC
Practice address
1410 Incarnation Dr
Suite 101
Charlottesville, VA 22901-5708
Phone
(434) 978-4915
Fax
(434) 978-7194
NPI assigned
Apr 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2012

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

Authorized official

Name
Mark W Tulenko, MPT OCS
Title
Director
Phone
(434) 978-4915

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 2315014631 VA Primary
Rehabilitation Clinic/Center 261QR0400X 2305004631 VA

Addresses

Primary practice location

1410 Incarnation Dr
Suite 101
Charlottesville, VA 22901-5708

Mailing address

1410 Incarnation Dr
Suite 101
Charlottesville, VA 22901-5708
Phone (434) 978-4915

Other identifiers 1

IdentifierTypeStateIssuer
004980328MedicaidVA

Other names 1

  • Physical Therapy Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120703000405 VA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5799940433 Practice locations: Charlottesville, VA

National Provider Directory

National Provider Directory
Tax ID family
Atlantic Sports Rehab Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341273600000",
    "number": "1952363822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 INCARNATION DR",
            "address_2": "SUITE 101",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229015708",
            "telephone_number": "434-978-4915",
            "fax_number": "434-978-7194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 INCARNATION DR",
            "address_2": "SUITE 101",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229015708",
            "telephone_number": "434-978-4915",
            "fax_number": "434-978-7194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC SPORTS & REHABILITATION SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2012-07-03",
        "status": "A",
        "authorized_official_last_name": "TULENKO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "434-978-4915",
        "authorized_official_credential": "MPT OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2315014631",
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "VA",
            "license": "2305004631",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004980328",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charlottesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; 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.