Provider Demographics
NPI:1710324280
Name:ADVANCE PHYSICAL THERAPY AND REHAB, P.C.
Entity Type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY AND REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SATYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:231-884-0239
Mailing Address - Street 1:1101 N MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1200
Mailing Address - Country:US
Mailing Address - Phone:231-884-0239
Mailing Address - Fax:
Practice Address - Street 1:1101 N MITCHELL ST UNIT 16
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1200
Practice Address - Country:US
Practice Address - Phone:231-779-2526
Practice Address - Fax:231-779-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty