MEDICARE: ADVANCE PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00007787	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	G8865497	OTHER	WA	MEDICARE
6	GAB18641	OTHER	WA	MEDICARE (OLD IND NUMBER)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0142606	OTHER	WA	DEPT OF L & I
2	8940084	OTHER	WA	CRIME VICTIMS ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5411BE	OTHER	WA	REGENCE ID
7	353866900	OTHER	WA	FEDERAL LABOR ID

General Provider Information

NPI Number	:	1598725798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	15623 1ST AVE S
Second Line	:	STE C
City	:	BURIEN
State	:	WA
Zip	:	98148-1292
Country	:	US
Telephone Number	:	206-444-6320
Fax Number	:	206-444-6302

Provider Business Practice Location Address
First Line	:	15623 1ST AVE S
Second Line	:	STE C
City	:	BURIEN
State	:	WA
Zip	:	98148-1292
Country	:	US
Telephone Number	:	206-444-6320
Fax Number	:	206-444-6302

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. BRADFORD BENTLEY
Credential	:	DPT
Telephone Number	:	206-444-6320

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	03/22/2022

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Directions to “ADVANCE PHYSICAL THERAPY INC ” Practice Location

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