=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164732459
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HEALTH PHYSICAL THERAPY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2010
-----------------------------------------------------
Last Update Date | 10/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 EXECUTIVE DR SUITE 300
-----------------------------------------------------
City | NEW WINDSOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12553-5547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-787-0440
-----------------------------------------------------
Fax | 845-787-0441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 EXECUTIVE DR STE 300
-----------------------------------------------------
City | NEW WINDSOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12553-5546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-787-0440
-----------------------------------------------------
Fax | 845-787-0441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALLAN ANTHONY GUTIERREZ
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 845-787-0440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 016020
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------