Provider Demographics
NPI:1962667642
Name:ADVANCED PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:GORNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-580-1320
Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2800
Mailing Address - Country:US
Mailing Address - Phone:410-415-0005
Mailing Address - Fax:410-415-0006
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-2891
Practice Address - Country:US
Practice Address - Phone:410-415-0005
Practice Address - Fax:410-415-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty