Provider Demographics
NPI:1073882304
Name:ADVANCE PHYSICAL THERAPY & SPORTS MEDICINE OF ADAMS COUNTY LLC
Entity Type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY & SPORTS MEDICINE OF ADAMS COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:217-222-6800
Mailing Address - Street 1:160 PROGRESS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6630
Mailing Address - Country:US
Mailing Address - Phone:217-222-6800
Mailing Address - Fax:217-222-0037
Practice Address - Street 1:4800 MAINE ST STE 48-100
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5875
Practice Address - Country:US
Practice Address - Phone:217-222-6800
Practice Address - Fax:217-222-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy