Provider Demographics
NPI:1558407759
Name:ADVANCE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-827-9446
Mailing Address - Street 1:400 N BROADWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2113
Mailing Address - Country:US
Mailing Address - Phone:516-827-9446
Mailing Address - Fax:516-827-0042
Practice Address - Street 1:910 ROUTE 109
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1158
Practice Address - Country:US
Practice Address - Phone:631-225-1289
Practice Address - Fax:631-225-6143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty