Provider Demographics
NPI:1689963324
Name:ADVANCED PT SERVICES, INC
Entity Type:Organization
Organization Name:ADVANCED PT SERVICES, INC
Other - Org Name:ADVANCED THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-596-8161
Mailing Address - Street 1:PO BOX L
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:TX
Mailing Address - Zip Code:77975-0360
Mailing Address - Country:US
Mailing Address - Phone:361-596-8161
Mailing Address - Fax:361-596-8163
Practice Address - Street 1:105 BOEHM DR
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-6288
Practice Address - Country:US
Practice Address - Phone:361-594-8301
Practice Address - Fax:361-594-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy