Provider Demographics
NPI:1508182759
Name:ADVANTAGE PHYSICAL THERAPY OF BATTLE CREEK, INC
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY OF BATTLE CREEK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:269-979-2100
Mailing Address - Street 1:4770 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7932
Mailing Address - Country:US
Mailing Address - Phone:269-979-2100
Mailing Address - Fax:269-979-2658
Practice Address - Street 1:4770 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7932
Practice Address - Country:US
Practice Address - Phone:269-979-2100
Practice Address - Fax:269-979-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003373225100000X
MI5501004262225100000X
MI5201002285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM37060Medicare PIN