Provider Demographics
NPI:1982829602
Name:ADVANCED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-563-1616
Mailing Address - Street 1:2000 VAN NESS AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3020
Mailing Address - Country:US
Mailing Address - Phone:415-563-1616
Mailing Address - Fax:
Practice Address - Street 1:2000 VAN NESS AVE STE 304
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3020
Practice Address - Country:US
Practice Address - Phone:415-563-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty