1487984951 NPI number — ADVANCED PHYSICAL THERAPY,LLC

Table of content: (NPI 1487984951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487984951 NPI number — ADVANCED PHYSICAL THERAPY,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED 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:
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 Information

NPI Number:
1487984951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASLEY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29641-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-343-2650
Provider Business Mailing Address Fax Number:
864-343-2680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 BRUSHY CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASLEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29642-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-343-2650
Provider Business Practice Location Address Fax Number:
864-343-2680
Provider Enumeration Date:
01/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
EMBLER
Authorized Official First Name:
JASON
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
864-343-2650

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9429 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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