Provider Demographics
NPI:1679966220
Name:ADVANTAGE PT ASSOCIATES INC
Entity Type:Organization
Organization Name:ADVANTAGE PT ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:630-901-3870
Mailing Address - Street 1:400 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4912
Mailing Address - Country:US
Mailing Address - Phone:630-901-3870
Mailing Address - Fax:
Practice Address - Street 1:400 E 18TH ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4912
Practice Address - Country:US
Practice Address - Phone:630-901-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-002882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty