MEDICARE: ADVANCED PHYSICAL THERAPY, 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	53000009A	IN
2	225X00000X	Occupational Therapist		IN
3	225100000X	Physical Therapist		IN

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	:	1316940505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	360-296-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	5949 W RAYMOND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-1612
Country	:	US
Telephone Number	:	317-390-5599
Fax Number	:	317-486-2189

Authorized Official
Title or Position	:	VP CHIEF COMPLIANCE OFFICER
Name	:	WADE A MEYER
Credential	:
Telephone Number	:	630-296-2223

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/26/2024

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