Provider Demographics
NPI:1952308637
Name:ADVANCED PHYSICAL THERAPY AND REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY AND REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WANCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-228-3000
Mailing Address - Street 1:15870 19 MILE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3529
Mailing Address - Country:US
Mailing Address - Phone:586-228-3000
Mailing Address - Fax:586-228-3066
Practice Address - Street 1:15870 19 MILE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3529
Practice Address - Country:US
Practice Address - Phone:586-228-3000
Practice Address - Fax:586-228-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236722Medicare ID - Type Unspecified