Healthcare Provider Details

I. General information

NPI: 1235315037
Provider Name (Legal Business Name): ADVANCED PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 S POPLAR ST
HAZLETON PA
18201-7732
US

IV. Provider business mailing address

497 S POPLAR ST
HAZLETON PA
18201-7732
US

V. Phone/Fax

Practice location:
  • Phone: 570-956-9064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT011618L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA STEFFES
Title or Position: OWNER ADVANCED PHYSICAL THERAPY
Credential: DPT, MTC, NCTMB
Phone: 570-956-9064