=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821222985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APEX PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2009
-----------------------------------------------------
Last Update Date | 05/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9085 STATE RTE 34 N.
-----------------------------------------------------
City | GALATIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62935-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-651-0444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 APEX DR
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62249-1282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-651-0444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | MR. BRADLEY R. PFITZNER
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 618-651-0444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------