Provider Demographics
NPI:1033156013
Name:ADVANTAGE PHYSICAL THERAPY, PA
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT. /PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT / ATC
Authorized Official - Phone:732-262-0111
Mailing Address - Street 1:990 CEDARBRIDGE AVE
Mailing Address - Street 2:TOWNE HALL SHOPPES
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4159
Mailing Address - Country:US
Mailing Address - Phone:732-262-0111
Mailing Address - Fax:732-262-0332
Practice Address - Street 1:990 CEDARBRIDGE AVE
Practice Address - Street 2:TOWNE HALL SHOPPES
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4159
Practice Address - Country:US
Practice Address - Phone:732-262-0111
Practice Address - Fax:732-262-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00661600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068063Medicare ID - Type Unspecified
=========Medicare UPIN