Healthcare Provider Details

I. General information

NPI: 1952955817
Provider Name (Legal Business Name): ADVANCED PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 E. 19TH AVENUE
WINFIELD KS
67156
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 316-263-0003
  • Fax:
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 CHARLES TODD
Title or Position: OWNER
Credential:
Phone: 316-263-0003