Provider Demographics
NPI:1598725798
Name:ADVANCE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:206-444-6320
Mailing Address - Street 1:15623 1ST AVE S
Mailing Address - Street 2:STE C
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1292
Mailing Address - Country:US
Mailing Address - Phone:206-444-6320
Mailing Address - Fax:206-444-6302
Practice Address - Street 1:15623 1ST AVE S
Practice Address - Street 2:STE C
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1292
Practice Address - Country:US
Practice Address - Phone:206-444-6320
Practice Address - Fax:206-444-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0142606OtherDEPT OF L & I
WA8940084OtherCRIME VICTIMS ID
WA7104300Medicaid
WAG8865497OtherMEDICARE
WA5411BEOtherREGENCE ID
WAGAB18641OtherMEDICARE (OLD IND NUMBER)
WA353866900OtherFEDERAL LABOR ID