Provider Demographics
NPI:1649507914
Name:ADVANCED PT, LLC
Entity type:Organization
Organization Name:ADVANCED PT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:316-260-6869
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE. 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:430 W IOWA AVE
Practice Address - Street 2:STE. B
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2826
Practice Address - Country:US
Practice Address - Phone:208-466-2200
Practice Address - Fax:208-466-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-07
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty