Provider Demographics
NPI:1932113776
Name:ADVANTAGE PHYSICAL THERAPY & SPORTS PERFORMANCE, P.C.
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY & SPORTS PERFORMANCE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:540-434-1200
Mailing Address - Street 1:381 LUCY DR
Mailing Address - Street 2:A
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8050
Mailing Address - Country:US
Mailing Address - Phone:540-434-1200
Mailing Address - Fax:540-434-1203
Practice Address - Street 1:381 LUCY DR
Practice Address - Street 2:A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8050
Practice Address - Country:US
Practice Address - Phone:540-434-1200
Practice Address - Fax:540-434-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192959OtherANTHEM BLUE CROSS/BLUE SH
VA192959OtherANTHEM BLUE CROSS/BLUE SH