Provider Demographics
NPI:1770843443
Name:ADVANCED PHYSICAL THERAPY SERVICES, LTD
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY SERVICES, LTD
Other - Org Name:ADVANCED REHAB & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:309-661-8823
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-0047
Mailing Address - Country:US
Mailing Address - Phone:309-661-8823
Mailing Address - Fax:309-661-8801
Practice Address - Street 1:103 SE 15TH AVE
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1808
Practice Address - Country:US
Practice Address - Phone:309-661-8823
Practice Address - Fax:309-661-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010041261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy