Provider Demographics
NPI:1184965436
Name:ADVANCED PHYSICAL THERAPY AND FITNESS, LLC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY AND FITNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HIEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-751-3001
Mailing Address - Street 1:1000 TACOMA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7036
Mailing Address - Country:US
Mailing Address - Phone:701-751-3001
Mailing Address - Fax:
Practice Address - Street 1:1033 BASIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6649
Practice Address - Country:US
Practice Address - Phone:701-223-6613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55715Medicaid
ND55715Medicaid