Healthcare Provider Details

I. General information

NPI: 1710292537
Provider Name (Legal Business Name): ADVANCED PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W WASHINGTON AVE
STERLING KS
67579-1615
US

IV. Provider business mailing address

200 W DOUGLAS AVE STE 1040
WICHITA KS
67202-3013
US

V. Phone/Fax

Practice location:
  • Phone: 620-662-3111
  • Fax: 620-662-3112
Mailing address:
  • Phone: 316-263-0003
  • Fax: 316-263-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
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 CHARLES TODD
Title or Position: OWNER
Credential:
Phone: 316-263-0003