Provider Demographics
NPI:1831363738
Name:AMPT ADVANCED MANUAL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:AMPT ADVANCED MANUAL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KABBAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:608-441-0032
Mailing Address - Street 1:1000 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2137
Mailing Address - Country:US
Mailing Address - Phone:312-243-0031
Mailing Address - Fax:312-243-0032
Practice Address - Street 1:1000 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2137
Practice Address - Country:US
Practice Address - Phone:312-243-0031
Practice Address - Fax:312-243-0032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMPT ADVANCED MANUAL PHYSICAL THERAPY SPECIALTY PT CLINICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0144632251X0800X
IL070-0136142251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty