Provider Demographics
NPI:1437586278
Name:ADVANCE PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:
Authorized Official - Last Name:TENUTA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:262-925-5002
Mailing Address - Street 1:S74W17045 JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-9701
Mailing Address - Country:US
Mailing Address - Phone:414-442-4678
Mailing Address - Fax:414-442-4735
Practice Address - Street 1:S74W17045 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9701
Practice Address - Country:US
Practice Address - Phone:414-442-4678
Practice Address - Fax:414-442-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40381600Medicaid