MEDICARE: ADVANCED PT LLC

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	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC6719	OTHER	KS	RETIRED RAILROAD MEDICARE

General Provider Information

NPI Number	:	1144251232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PT LLC

Provider Business Mailing Address
First Line	:	200 W DOUGLAS
Second Line	:	STE 1040
City	:	WICHITA
State	:	KS
Zip	:	67202-3017
Country	:	US
Telephone Number	:	316-263-0003
Fax Number	:	316-263-1241

Provider Business Practice Location Address
First Line	:	8437 STATE AVE
Second Line	:	STE B
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-1842
Country	:	US
Telephone Number	:	913-299-9616
Fax Number	:	913-299-9617

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	DAVID C TODD
Credential	:	P.T.
Telephone Number	:	316-260-6869

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/15/2010

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Directions to “ADVANCED PT LLC ” Practice Location

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