Provider Demographics
NPI:1881838969
Name:PHYSICAL THERAPY ADVANTAGE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ADVANTAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-251-8003
Mailing Address - Street 1:232 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1085
Mailing Address - Country:US
Mailing Address - Phone:570-251-8003
Mailing Address - Fax:570-251-8003
Practice Address - Street 1:1446 E LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447
Practice Address - Country:US
Practice Address - Phone:570-383-8700
Practice Address - Fax:570-383-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty