Healthcare Provider Details

I. General information

NPI: 1437141504
Provider Name (Legal Business Name): ADVANCED PHYSICAL THERAPY SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N WILLIAMSBURG DRIVE
BLOOMINGTON IL
61704
US

IV. Provider business mailing address

PO BOX 47
BLOOMINGTON IL
61702-0047
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-8823
  • Fax: 309-661-8801
Mailing address:
  • Phone: 309-661-8823
  • Fax: 309-661-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name: MICHAEL R SALAWAY
Title or Position: PRESIDENT OF OPERATIONS
Credential:
Phone: 309-661-8823