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General NPI Number Information
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NPI Number | 1679966220
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PT ASSOCIATES INC
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 400 E 18TH ST
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City | LOMBARD
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State | IL
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Zip | 60148-4912
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Country | US
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Telephone | 630-901-3870
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E 18TH ST
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City | LOMBARD
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State | IL
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Zip | 60148-4912
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Country | US
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Telephone | 630-901-3870
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. JAMES A DALLAS
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Credential | LPT
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Telephone | 630-901-3870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070-002882
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License Number State | IL
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