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NPI Code Detail

MEDICARE: ADVANCED PT, LLC

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
1225100000XPhysical Therapist11-02726KS

Other Identifiers

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

General Provider Information

NPI Number : 1629301155
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED PT, LLC
Provider Business Mailing Address
First Line : 200 W DOUGLAS AVE
Second Line : STE. 1040
City : WICHITA
State : KS
Zip : 67202-3013
Country : US
Telephone Number : 316-263-0003
Fax Number : 316-263-1241
Provider Business Practice Location Address
First Line : 239 N BROADWAY AVE
Second Line :
City : STERLING
State : KS
Zip : 67579-1916
Country : US
Telephone Number : 620-204-6116
Fax Number : 620-204-6116
Authorized Official
Title or Position : OWNER
Name : DAVID C TODD
Credential : PT
Telephone Number : 316-260-6869
Provider Enumeration Date : 09/16/2009
Last Update Date : 09/16/2009

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