Provider Demographics
NPI:1023317401
Name:ADVANCE PHYSICAL THERAPY & REHABILITATION LLC
Entity type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:732-589-0880
Mailing Address - Street 1:401 MCDOWELL DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4084
Mailing Address - Country:US
Mailing Address - Phone:732-589-0880
Mailing Address - Fax:732-387-8788
Practice Address - Street 1:21 KILMER DR
Practice Address - Street 2:BLDG. 2 SUITE D
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1571
Practice Address - Country:US
Practice Address - Phone:732-589-0880
Practice Address - Fax:732-387-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty