1750691572 NPI number — ADVANTAGE PHYSICAL THERAPY & REHAB, INC.

Table of content: (NPI 1750691572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750691572 NPI number — ADVANTAGE PHYSICAL THERAPY & REHAB, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE PHYSICAL THERAPY & REHAB, 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'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:
1750691572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2213 GRAND AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50312-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-237-3974
Provider Business Mailing Address Fax Number:
515-883-2692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7564 HICKMAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50324-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-276-1111
Provider Business Practice Location Address Fax Number:
515-864-0391
Provider Enumeration Date:
10/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GOODHUE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PARTNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
515-276-1111

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  02018 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1750691572 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 615606502 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: DT2836 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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