Healthcare Provider Details

I. General information

NPI: 1053906404
Provider Name (Legal Business Name): ADVANCED PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4515 E CENTRAL AVE STE A
WICHITA KS
67208-3915
US

IV. Provider business mailing address

200 W DOUGLAS AVE STE 250
WICHITA KS
67202-3002
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-6869
  • Fax: 316-260-6872
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: CEO
Credential:
Phone: 316-263-0003