Provider Demographics
NPI:1821277229
Name:ADVANCED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:EASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:919-740-6486
Mailing Address - Street 1:7212 MADIERA CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3328
Mailing Address - Country:US
Mailing Address - Phone:919-740-6486
Mailing Address - Fax:
Practice Address - Street 1:3100 NC HIGHWAY 55
Practice Address - Street 2:SUITE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:919-290-2799
Practice Address - Fax:919-290-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10785261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy