Provider Demographics
NPI:1215266408
Name:ADVANCE PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ARNESON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:320-631-2302
Mailing Address - Street 1:309 1ST ST NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-4635
Mailing Address - Country:US
Mailing Address - Phone:320-631-2302
Mailing Address - Fax:320-631-2303
Practice Address - Street 1:309 1ST ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-4635
Practice Address - Country:US
Practice Address - Phone:320-631-2302
Practice Address - Fax:320-631-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6452261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DQ6109OtherRAILROAD MEDICARE GROUP PTAN
P00857989OtherRAILROAD MEDICARE PROVIDER PTAN
C05455OtherMEDICARE GROUP PTAN
650002334OtherMEDICARE PROVIDER PTAN
MN6368000001Medicare NSC