Provider Demographics
NPI:1013940899
Name:ADVANCE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-253-3300
Mailing Address - Street 1:150 CHASE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8104
Mailing Address - Country:US
Mailing Address - Phone:610-746-9432
Mailing Address - Fax:
Practice Address - Street 1:318 TOWN CENTER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8366
Practice Address - Country:US
Practice Address - Phone:610-253-3300
Practice Address - Fax:610-253-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013574L225100000X
PAPT013653L225100000X
PAPT016511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAD1436033OtherBLUE SHIELD
PA02999500OtherCAPITAL BLUE CROSS
PA5912334OtherCIGNA
PADA1820OtherRAILROAD MEDICARE
PAP11192619OtherMULTIPLAN
PA7618519OtherAETNA
PAP2607186OtherOXFORD
PA2120902000OtherPERSONAL CHOICE INDEPENDE
PA341-9140OtherAETNA HMO
PA960655OtherONE HEALTH PLAN OF PA
PW0246801OtherORTHONET
PA7692221OtherAETNA MANAGED PLAN
PA059732Medicare ID - Type Unspecified