Provider Demographics
NPI:1154331262
Name:ADVANCED PHYSICAL THERAPY CENTER, INC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-989-4564
Mailing Address - Street 1:PO BOX 392573
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9500
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:10809 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7029
Practice Address - Country:US
Practice Address - Phone:810-695-8700
Practice Address - Fax:810-695-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000455OtherTHERAMATRIX PROV ID NO.
MI000261F7OtherHAP PROVIDER ID NO.
MI5849317OtherCIGNA PROVIDER ID NO.
MI0141732OtherHEALTHPLUS PROV ID NO.
MI109526OtherPREF CHOICES PPO PRV ID #
MI30367OtherBLUE CROSS/BCN PROV ID #
MI4716268/40Medicaid
MIRT250002OtherM-CARE PROVIDER ID NO.
MI1011271OtherHLTH ADVANTAGE PROV ID #
MI4669970OtherAETNA PROVIDER ID NO.
MI109526OtherPREF CHOICES PPO PRV ID #
MI=========001OtherTRICARE FOR LIFE PRV ID #
MI236599Medicare ID - Type UnspecifiedPROVIDER ID NUMBER