Provider Demographics
NPI:1083942833
Name:ADVANCED PHYSICAL DYNAMICS PLLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL DYNAMICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MULFINGER
Authorized Official - Suffix:I
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:727-271-9156
Mailing Address - Street 1:3152 LITTLE RD STE 181
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1864
Mailing Address - Country:US
Mailing Address - Phone:727-271-9156
Mailing Address - Fax:
Practice Address - Street 1:11511 LOUNDS CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-6236
Practice Address - Country:US
Practice Address - Phone:727-271-9156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18909310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility