MEDICARE: ADVANCE PHYSICAL THERAPY & SPORTS REHAB. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	18214	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093954158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE PHYSICAL THERAPY & SPORTS REHAB. INC

Provider Business Mailing Address
First Line	:	3411 OLANDWOOD CT
Second Line	:	SUITE 106
City	:	OLNEY
State	:	MD
Zip	:	20832-1488
Country	:	US
Telephone Number	:	240-750-9966
Fax Number	:	301-774-1336

Provider Business Practice Location Address
First Line	:	3411 OLANDWOOD CT
Second Line	:	SUITE 106
City	:	OLNEY
State	:	MD
Zip	:	20832-1488
Country	:	US
Telephone Number	:	240-750-9966
Fax Number	:	301-774-1336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARIAN CUBA RUTA
Credential	:	D.P.T.
Telephone Number	:	301-570-3588

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	04/18/2012

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