Provider Demographics
NPI:1013169473
Name:ADVANCED CENTER FOR PHYSICAL THERAPY, PLC
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR PHYSICAL THERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-989-4564
Mailing Address - Street 1:PO BOX 392573
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9573
Mailing Address - Country:US
Mailing Address - Phone:724-584-5739
Mailing Address - Fax:
Practice Address - Street 1:5928 SEMINOLE TRL
Practice Address - Street 2:SUITE 103
Practice Address - City:BARBOURSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22923-2831
Practice Address - Country:US
Practice Address - Phone:434-985-2198
Practice Address - Fax:434-985-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8658261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09457Medicare PIN