Provider Demographics
NPI:1689784217
Name:ADVANCED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY
Other - Org Name:MICHAEL BEAUDOIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEAUDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:215-742-8099
Mailing Address - Street 1:2127 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3216
Mailing Address - Country:US
Mailing Address - Phone:215-742-8099
Mailing Address - Fax:215-742-1871
Practice Address - Street 1:2127 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3216
Practice Address - Country:US
Practice Address - Phone:215-742-8099
Practice Address - Fax:215-742-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012778L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01726303OtherHIGHMARK BLUE SHIELD
PA246902OtherHORIZON NJ PLUS
PA30023534OtherKEYSTONE MERCY
PA2395652000OtherINDEPENDENCE BLUE CROSS
3985602OtherAETNA
PA246902Medicare UPIN