Provider Demographics
NPI:1952386203
Name:ADVANCED PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WITTENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-560-9575
Mailing Address - Street 1:108 WALTON PARK LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3028
Mailing Address - Country:US
Mailing Address - Phone:804-560-9575
Mailing Address - Fax:804-560-9557
Practice Address - Street 1:108 WALTON PARK LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3028
Practice Address - Country:US
Practice Address - Phone:804-560-9575
Practice Address - Fax:804-560-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
114480OtherANTHEM
6400314OtherUHC
7933191OtherAETNA
7933191OtherAETNA