Provider Demographics
NPI:1043089337
Name:ADVANCED TRAVEL HEALTH LLC
Entity Type:Organization
Organization Name:ADVANCED TRAVEL HEALTH LLC
Other - Org Name:ADVANCED PHYSICAL THERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:858-265-7727
Mailing Address - Street 1:6915 FLANDERS DR STE D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6915 FLANDERS DR STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2987
Practice Address - Country:US
Practice Address - Phone:858-265-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty