Provider Demographics
NPI:1689701153
Name:ADVANTA MEDICAL & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANTA MEDICAL & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHUYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-955-2225
Mailing Address - Street 1:1480 TERRELL MILL RD SE
Mailing Address - Street 2:STE F BOX 884
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6050
Mailing Address - Country:US
Mailing Address - Phone:770-955-2225
Mailing Address - Fax:770-953-6658
Practice Address - Street 1:1720 POWERS FERRY RD SE
Practice Address - Street 2:STE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5450
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:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004850111NR0400X
NE261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy