Provider Demographics
NPI:1467407189
Name:ADVANCED PHYSICAL THERAPY SERVICES,LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPY
Authorized Official - Phone:742-627-0685
Mailing Address - Street 1:265 ELM DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8275
Mailing Address - Country:US
Mailing Address - Phone:724-627-0685
Mailing Address - Fax:724-627-0849
Practice Address - Street 1:265 ELM DR
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8275
Practice Address - Country:US
Practice Address - Phone:724-627-0685
Practice Address - Fax:724-627-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002279E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088517Medicare ID - Type Unspecified