Provider Demographics
NPI:1609158096
Name:ADVANTA MEDICAL & PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ADVANTA MEDICAL & PHYSICAL THERAPY PC
Other - Org Name:ADVANTA TOTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:SCHUYLER
Authorized Official - Suffix:I
Authorized Official - Credentials:D C
Authorized Official - Phone:770-955-2225
Mailing Address - Street 1:1720 POWERS FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5442
Mailing Address - Country:US
Mailing Address - Phone:770-955-2225
Mailing Address - Fax:770-953-6658
Practice Address - Street 1:1720 POWERS FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5442
Practice Address - Country:US
Practice Address - Phone:770-955-2225
Practice Address - Fax:770-953-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111N00000X, 207R00000X
208D00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty