Provider Demographics
NPI:1336214865
Name:ADVANCED PHYSICAL THERAPY OF ENGLEWOOD INC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY OF ENGLEWOOD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-474-6610
Mailing Address - Street 1:272 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3309
Mailing Address - Country:US
Mailing Address - Phone:941-474-6610
Mailing Address - Fax:941-474-6620
Practice Address - Street 1:272 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3309
Practice Address - Country:US
Practice Address - Phone:941-474-6610
Practice Address - Fax:941-474-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY906TOtherBCBS FACILITY GROUP
FL4482146OtherAETNA HMO ONLY
FLK2605Medicare ID - Type UnspecifiedFACILITY GROUP