Provider Demographics
NPI:1689702201
Name:ADVANCED PHYSICAL THERAPY & CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY & CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-292-8810
Mailing Address - Street 1:21 MILL ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-2010
Mailing Address - Country:US
Mailing Address - Phone:845-292-8810
Mailing Address - Fax:845-295-9156
Practice Address - Street 1:21 MILL ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2010
Practice Address - Country:US
Practice Address - Phone:845-292-8810
Practice Address - Fax:845-295-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty