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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1154963288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PT, LLC

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

Provider Business Practice Location Address
First Line	:	1755 E 61ST ST N
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1917
Country	:	US
Telephone Number	:	316-361-5425
Fax Number	:	316-361-3615

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID CHARLES TODD
Credential	:
Telephone Number	:	316-263-0003

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	10/10/2019

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Directions to “ADVANCED PT, LLC ” Practice Location

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