1154331262 NPI number — ADVANCED PHYSICAL THERAPY CENTER, INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154331262 NPI number — ADVANCED PHYSICAL THERAPY CENTER, INC

Employer Identification Number (EIN):

Provider Organization Name:

ADVANCED PHYSICAL THERAPY CENTER, INC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1154331262

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/25/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 392573

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PITTSBURGH

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

15251-9500

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

724-343-4060

Provider Business Mailing Address Fax Number:

724-343-4069

Provider First Line Business Practice Location Address:

10809 S SAGINAW ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GRAND BLANC

Provider Business Practice Location Address State Name:

MI

Provider Business Practice Location Address Postal Code:

48439-7029

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

810-695-8700

Provider Business Practice Location Address Fax Number:

810-695-7946

Provider Enumeration Date:

08/09/2006

Authorized Official Last Name:

LAU

Authorized Official First Name:

LAUREN

Authorized Official Middle Name:

Authorized Official Title or Position:

DIRECTOR OF CREDENTIALING

Authorized Official Telephone Number:

724-989-4564

• Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 000455 . This is a "THERAMATRIX PROV ID NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 000261F7 . This is a "HAP PROVIDER ID NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 5849317 . This is a "CIGNA PROVIDER ID NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 0141732 . This is a "HEALTHPLUS PROV ID NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 109526 . This is a "PREF CHOICES PPO PRV ID #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 30367 . This is a "BLUE CROSS/BCN PROV ID #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 4716268/40 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: RT250002 . This is a "M-CARE PROVIDER ID NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1011271 . This is a "HLTH ADVANTAGE PROV ID #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 4669970 . This is a "AETNA PROVIDER ID NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".