Provider Demographics
NPI:1790185460
Name:ADVANCED PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANZER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:703-728-3087
Mailing Address - Street 1:17153 MAGIC MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-4405
Mailing Address - Country:US
Mailing Address - Phone:703-728-3087
Mailing Address - Fax:
Practice Address - Street 1:200 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6100
Practice Address - Country:US
Practice Address - Phone:703-728-3087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty