Provider Demographics
NPI:1750611539
Name:ADVANCED SPECIALTY PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:ADVANCED SPECIALTY PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHUTTLEWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:724-630-5607
Mailing Address - Street 1:1750 NEW BUTLER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3184
Mailing Address - Country:US
Mailing Address - Phone:724-856-3268
Mailing Address - Fax:724-498-4333
Practice Address - Street 1:1750 NEW BUTLER RD
Practice Address - Street 2:SUITE D
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3184
Practice Address - Country:US
Practice Address - Phone:724-856-3268
Practice Address - Fax:724-498-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty