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General NPI Number Information
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NPI Number | 1386973097
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Entity Type | Organization
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Legal Business Name | ADVANCE PHYSICAL THERAPY CENTER
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 1665 S IMPERIAL AVE STE C
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City | EL CENTRO
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State | CA
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Zip | 92243-4247
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Country | US
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Telephone | 760-337-8300
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Fax | 760-337-8400
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Provider Business Mailing Address
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Address Line | PO BOX 2738
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City | EL CENTRO
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State | CA
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Zip | 92244-2738
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Country | US
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Telephone | 760-337-8300
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Fax | 760-337-8400
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GUADALUPE MEZA
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Credential |
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Telephone | 760-337-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 15189
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License Number State | CA
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