Provider Demographics
NPI:1326108119
Name:ADVANCED PHYSICAL THERAPY & SPORTS REHABILITATION
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY & SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOBODSKOI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:267-242-0077
Mailing Address - Street 1:10100 JAMISON AVENUE
Mailing Address - Street 2:JCCS GREATER NE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116
Mailing Address - Country:US
Mailing Address - Phone:267-968-0381
Mailing Address - Fax:
Practice Address - Street 1:10100 JAMISON AVE
Practice Address - Street 2:JCC GREATER NE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3832
Practice Address - Country:US
Practice Address - Phone:267-968-0381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty