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General NPI Number Information
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NPI Number | 1972780187
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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 | 01/30/2008
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 207 E HOLLY
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City | SARATOGA
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State | WY
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Zip | 82331
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Country | US
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Telephone | 307-326-8223
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1272
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City | SARATOGA
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State | WY
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Zip | 82331-1272
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Country | US
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Telephone | 608-345-7053
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRADLEY L FERGUSON
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Credential | MPT
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Telephone | 608-249-6239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 9632-024
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT-1763
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License Number State | WY
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