Provider Demographics
NPI:1083342653
Name:ADVANTAGE PHYSICAL THERAPY & WELNESS, P.C.
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY & WELNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, CSCS
Authorized Official - Phone:970-259-7829
Mailing Address - Street 1:3600 MAIN AVENUE SUITE A
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4082
Mailing Address - Country:US
Mailing Address - Phone:970-259-7829
Mailing Address - Fax:970-259-9411
Practice Address - Street 1:1305 ESCALANTE DR. # 203
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303
Practice Address - Country:US
Practice Address - Phone:970-403-8067
Practice Address - Fax:970-212-7321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANTAGE PHYSICAL THERAPY & WELLNESS ,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000190945Medicaid