Healthcare Provider Details

I. General information

NPI: 1336320340
Provider Name (Legal Business Name): ADVANCED PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W MAIN ST
INDEPENDENCE KS
67301-3511
US

IV. Provider business mailing address

200 W DOUGLAS STE 1040
WICHITA KS
67202-3017
US

V. Phone/Fax

Practice location:
  • Phone: 620-331-0999
  • Fax: 620-331-1065
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID C TODD
Title or Position: PT/OWNER
Credential: PT
Phone: 316-263-0003