Provider Demographics
NPI:1003099094
Name:ADVANTAGE THERAPY INC.
Entity Type:Organization
Organization Name:ADVANTAGE THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SWISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-648-1242
Mailing Address - Street 1:1272 CRAGSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545
Mailing Address - Country:US
Mailing Address - Phone:909-648-1242
Mailing Address - Fax:
Practice Address - Street 1:1272 CRAGSTONE DR
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-2169
Practice Address - Country:US
Practice Address - Phone:951-252-5392
Practice Address - Fax:888-768-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07409ZMedicare PIN