Provider Demographics
NPI:1790232866
Name:ADVANCED PHYSICAL MEDICINE INC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PICHARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-282-3615
Mailing Address - Street 1:12554 S JOHN YOUNG PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4004
Mailing Address - Country:US
Mailing Address - Phone:407-282-3615
Mailing Address - Fax:407-275-7221
Practice Address - Street 1:12554 S JOHN YOUNG PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4004
Practice Address - Country:US
Practice Address - Phone:407-282-3615
Practice Address - Fax:407-275-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty