Provider Demographics
NPI:1134264096
Name:ADVANTAGE PHYSICAL THERAPY & SPORTS PERFORMANCE, P.C.
Entity type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY & SPORTS PERFORMANCE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:540-434-1200
Mailing Address - Street 1:54 FRANKLIN ST
Mailing Address - Street 2:VILLAGE SQUARE PLAZA
Mailing Address - City:WEYERS CAVE
Mailing Address - State:VA
Mailing Address - Zip Code:24486-2340
Mailing Address - Country:US
Mailing Address - Phone:540-234-8800
Mailing Address - Fax:540-234-8939
Practice Address - Street 1:54 FRANKLIN ST
Practice Address - Street 2:VILLAGE SQUARE PLAZA
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486-2340
Practice Address - Country:US
Practice Address - Phone:540-234-8800
Practice Address - Fax:540-234-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA294391OtherANTHEM
VA299393OtherANTHEM OT
VA5934120002Medicare NSC