Healthcare Provider Details

I. General information

NPI: 1861921538
Provider Name (Legal Business Name): ADVANCED PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 N MULBERRY RD
DERBY KS
67037-3532
US

IV. Provider business mailing address

200 W DOUGLAS AVE STE 1040
WICHITA KS
67202-3017
US

V. Phone/Fax

Practice location:
  • Phone: 316-202-0996
  • Fax: 316-202-0997
Mailing address:
  • Phone: 316-263-0003
  • Fax: 316-263-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID TODD
Title or Position: OWNER / PHYSICAL THERAPIST
Credential: MPT
Phone: 316-263-0003