Provider Demographics
NPI:1770516809
Name:APEX PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:APEX PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PFITZNER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:618-651-0444
Mailing Address - Street 1:15 APEX DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1282
Mailing Address - Country:US
Mailing Address - Phone:618-651-0444
Mailing Address - Fax:618-654-5439
Practice Address - Street 1:2 SUNSET HILLS PROFESSIONAL CTR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3760
Practice Address - Country:US
Practice Address - Phone:618-692-4280
Practice Address - Fax:618-692-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056000312261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO186307OtherBCBS OF MISSOURI
IL204081700OtherUS DEPT OF LABOR
IL5535611OtherCCN
IL7734423OtherAETNA
IL06032069OtherBCBS OF ILLINOIS
IL469595OtherHEALTHLINK
IL168804OtherGHP
IL2134393OtherFIRST HEALTH
IL3863264OtherCIGNA
IL64-00598OtherUHC
IL64-00598OtherUHC