MEDICARE: ADVANCED PHYSICAL MEDICINE & THERAPY, LTD.

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
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1625375	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1659343713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PHYSICAL MEDICINE & THERAPY, LTD.

Provider Business Mailing Address
First Line	:	350 W KENSINGTON RD STE 102
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-222-9060
Fax Number	:	847-222-9130

Provider Business Practice Location Address
First Line	:	350 W KENSINGTON RD STE 102
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-222-9060
Fax Number	:	847-222-9130

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIJAY PATEL
Credential	:	DC
Telephone Number	:	847-222-9060

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	10/29/2020

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