Provider Demographics
NPI:1477724698
Name:ADVANTAGE PHYSICAL THERAPY & WELLNESS, PC
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:NIGHSWANDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:517-265-4075
Mailing Address - Street 1:190 WITTS END
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49238-9402
Mailing Address - Country:US
Mailing Address - Phone:517-605-6556
Mailing Address - Fax:
Practice Address - Street 1:227 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1582
Practice Address - Country:US
Practice Address - Phone:517-265-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008025261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy