Provider Demographics
NPI:1205027240
Name:ADVANTAGE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MATEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-767-5842
Mailing Address - Street 1:1657 DORSEY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3378
Mailing Address - Country:US
Mailing Address - Phone:404-767-5842
Mailing Address - Fax:404-767-5894
Practice Address - Street 1:1657 DORSEY AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3378
Practice Address - Country:US
Practice Address - Phone:404-767-5842
Practice Address - Fax:404-767-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6409Medicare PIN