Provider Demographics
NPI:1407977002
Name:AMPT ADVANCED MANUAL PHYSICAL THERAPY SPECIALTY PT CLINICS, INC.
Entity Type:Organization
Organization Name:AMPT ADVANCED MANUAL PHYSICAL THERAPY SPECIALTY PT CLINICS, INC.
Other - Org Name:HEAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:KABBAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MMPT, FAAOMPT, COMT
Authorized Official - Phone:608-441-0032
Mailing Address - Street 1:5900 MONONA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3561
Mailing Address - Country:US
Mailing Address - Phone:608-441-0032
Mailing Address - Fax:608-441-0034
Practice Address - Street 1:2000 ENGEL ST STE 102
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4822
Practice Address - Country:US
Practice Address - Phone:608-441-0032
Practice Address - Fax:608-441-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5161-024261QP2000X
IN05004602A261QP2000X
IL070-014463261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy