Provider Demographics
NPI:1851716252
Name:ADVANCE PHYSICAL THERAPY SPECIALISTS
Entity Type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:ACCIAVATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-292-6699
Mailing Address - Street 1:705 GREENBAG RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1589
Mailing Address - Country:US
Mailing Address - Phone:304-292-6699
Mailing Address - Fax:304-292-2282
Practice Address - Street 1:705 GREENBAG RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1589
Practice Address - Country:US
Practice Address - Phone:304-292-6699
Practice Address - Fax:304-292-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-22
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty