Provider Demographics
NPI:1578519468
Name:ADVANCED PHYSICAL THERAPY EAST LTD
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY EAST LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARRAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:AZORDEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:604-754-9619
Mailing Address - Street 1:2469 HERITAGE VLG
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6140
Mailing Address - Country:US
Mailing Address - Phone:604-754-9619
Mailing Address - Fax:770-979-0395
Practice Address - Street 1:2469 HERITAGE VLG
Practice Address - Street 2:SUITE 14
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6140
Practice Address - Country:US
Practice Address - Phone:604-754-9619
Practice Address - Fax:770-979-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2006OCC-0448261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116865Medicare Oscar/Certification