Provider Demographics
NPI:1457991275
Name:ADVANCED PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JOHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-428-9006
Mailing Address - Street 1:8821 UNIVERSITY EAST DR # 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4200
Mailing Address - Country:US
Mailing Address - Phone:704-428-9006
Mailing Address - Fax:
Practice Address - Street 1:8821 UNIVERSITY EAST DR # 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4200
Practice Address - Country:US
Practice Address - Phone:704-428-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty