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General NPI Number Information
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NPI Number | 1326108119
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICAL THERAPY & SPORTS REHABILITATION
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10100 JAMISON AVE JCC GREATER NE
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3832
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Country | US
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Telephone | 267-968-0381
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Fax |
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Provider Business Mailing Address
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Address Line | 10100 JAMISON AVENUE JCCS GREATER NE
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City | PHILADELPHIA
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State | PA
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Zip | 19116
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Country | US
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Telephone | 267-968-0381
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MIKHAIL SLOBODSKOI
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Credential | PT
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Telephone | 267-242-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT018210
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License Number State | PA
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