Provider Demographics
NPI:1518912567
Name:ADVANTAGE PHYSICAL THERAPY & REHABILITATION, LLC
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-468-1002
Mailing Address - Street 1:7560 GARDNER PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155
Mailing Address - Country:US
Mailing Address - Phone:703-468-1002
Mailing Address - Fax:703-468-1102
Practice Address - Street 1:7560 GARDNER PARK DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:703-468-1002
Practice Address - Fax:703-468-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty