Provider Demographics
NPI:1376522540
Name:AVANTE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AVANTE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-463-9443
Mailing Address - Street 1:1505 SW CARY PKWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6219
Mailing Address - Country:US
Mailing Address - Phone:919-463-9443
Mailing Address - Fax:919-463-9466
Practice Address - Street 1:1505 SW CARY PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6219
Practice Address - Country:US
Practice Address - Phone:919-463-9443
Practice Address - Fax:919-463-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012AMOtherBCBSNC
NC2500016Medicare PIN