MEDICARE: ADVANCE PHYSICAL THERAPY CENTER

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	111N00000X	Chiropractor	15189	CA

General Provider Information

NPI Number	:	1386973097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE PHYSICAL THERAPY CENTER

Provider Business Mailing Address
First Line	:	PO BOX 2738
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92244-2738
Country	:	US
Telephone Number	:	760-337-8300
Fax Number	:	760-337-8400

Provider Business Practice Location Address
First Line	:	1665 S IMPERIAL AVE STE C
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4247
Country	:	US
Telephone Number	:	760-337-8300
Fax Number	:	760-337-8400

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	GUADALUPE MEZA
Credential	:
Telephone Number	:	760-337-8300

Provider Enumeration Date	:	12/09/2009
Last Update Date	:	12/09/2009

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Directions to “ADVANCE PHYSICAL THERAPY CENTER ” Practice Location

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