Provider Demographics
NPI:1740432210
Name:ADVANTAGE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:401-272-2774
Mailing Address - Street 1:298 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1025
Mailing Address - Country:US
Mailing Address - Phone:401-272-2774
Mailing Address - Fax:401-272-2776
Practice Address - Street 1:298 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1025
Practice Address - Country:US
Practice Address - Phone:401-272-2774
Practice Address - Fax:401-272-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01379261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy