1770516809 NPI number — APEX PHYSICAL THERAPY, LLC

Table of content: (NPI 1770516809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770516809 NPI number — APEX PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX PHYSICAL THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
APEXNETWORK PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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 Information

NPI Number:
1770516809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 APEX DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62249-1282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-651-0444
Provider Business Mailing Address Fax Number:
618-654-5439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SUNSET HILLS PROFESSIONAL CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62025-3760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-692-4280
Provider Business Practice Location Address Fax Number:
618-692-9730
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PFITZNER
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
618-651-0444

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  056000312 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 186307 . This is a "BCBS OF MISSOURI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 204081700 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5535611 . This is a "CCN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7734423 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 06032069 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 469595 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 168804 . This is a "GHP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2134393 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3863264 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 64-00598 . This is a "UHC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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