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General NPI Number Information
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NPI Number | 1710618673
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 3510 PORTAGE RD
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City | SOUTH BEND
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State | IN
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Zip | 46628-6091
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Country | US
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Telephone | 574-203-9527
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP CHIEF COMPLIANCE OFFICER
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Name | WADE A MEYER
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Credential |
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Telephone | 630-296-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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