Provider Demographics
NPI:1891865648
Name:ADVANCED PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-390-5590
Mailing Address - Street 1:39827 TREASURY CENTER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-9800
Mailing Address - Country:US
Mailing Address - Phone:317-390-5599
Mailing Address - Fax:317-486-2189
Practice Address - Street 1:5949 W RAYMOND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-1612
Practice Address - Country:US
Practice Address - Phone:317-390-5599
Practice Address - Fax:317-486-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN53000048A225100000X, 225X00000X
225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN53000048AOtherLICENSE NUMBER
IN100239270Medicaid
IN156522Medicare PIN