Provider Demographics
NPI:1073652822
Name:ADVANCED PHYSICAL THERAPY AND ORTHOPEDIC REHABILITATION PC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY AND ORTHOPEDIC REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:541-773-7776
Mailing Address - Street 1:1910 E BARNETT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8672
Mailing Address - Country:US
Mailing Address - Phone:541-773-7776
Mailing Address - Fax:541-773-7786
Practice Address - Street 1:1910 E BARNETT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8672
Practice Address - Country:US
Practice Address - Phone:541-773-7776
Practice Address - Fax:541-773-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT3277225100000X
ORPTA7591225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00117730OtherRAIL ROAD MEDICARE
OR209044Medicaid
3000166OtherGEHA
0007177429OtherAETNA
DB6155OtherRAIL ROAD MEDICARE
K332601OtherPACIFIC SOURCE
DB6155OtherRAIL ROAD MEDICARE
R118358Medicare ID - Type Unspecified