Healthcare Provider Details

I. General information

NPI: 1609158096
Provider Name (Legal Business Name): ADVANTA MEDICAL & PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 POWERS FERRY RD SUITE 100
MARIETTA GA
30067-5442
US

IV. Provider business mailing address

1720 POWERS FERRY RD SUITE 100
MARIETTA GA
30067-5442
US

V. Phone/Fax

Practice location:
  • Phone: 770-955-2225
  • Fax: 770-953-6658
Mailing address:
  • Phone: 770-955-2225
  • Fax: 770-953-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD PHILIP SCHUYLER I
Title or Position: PRESIDENT
Credential: D. C.
Phone: 770-955-2225