Provider Demographics
NPI:1528219607
Name:ADVANCED PHYSICAL THERAPY SERVICES, LTD.
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY SERVICES, LTD.
Other - Org Name:ADVANCED REHAB AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SALAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-337-4408
Mailing Address - Street 1:PO BOX 5387
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-5387
Mailing Address - Country:US
Mailing Address - Phone:309-661-8823
Mailing Address - Fax:309-661-8801
Practice Address - Street 1:322 DOWNEND RD
Practice Address - Street 2:
Practice Address - City:TOULON
Practice Address - State:IL
Practice Address - Zip Code:61483-5089
Practice Address - Country:US
Practice Address - Phone:309-286-2070
Practice Address - Fax:309-286-2070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PHYSICAL THERAPY SERVICES, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty