Provider Demographics
NPI:1841461118
Name:ADVANCED PT & REHAB
Entity type:Organization
Organization Name:ADVANCED PT & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-886-4315
Mailing Address - Street 1:18531 ROSCOE BLVD STE 215A
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5462
Mailing Address - Country:US
Mailing Address - Phone:818-886-4315
Mailing Address - Fax:818-886-4316
Practice Address - Street 1:18531 ROSCOE BLVD
Practice Address - Street 2:STE 215A
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5462
Practice Address - Country:US
Practice Address - Phone:818-886-4315
Practice Address - Fax:818-886-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15720Medicare UPIN