Provider Demographics
NPI:1285819664
Name:AMPT ADVANCED MANUAL PHYSICAL THERAPY SPECIALTY PT CLINICS, LLC
Entity type:Organization
Organization Name:AMPT ADVANCED MANUAL PHYSICAL THERAPY SPECIALTY PT CLINICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KABBAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:608-441-0032
Mailing Address - Street 1:8310 ALLISON POINTE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1981
Mailing Address - Country:US
Mailing Address - Phone:317-576-0001
Mailing Address - Fax:317-576-0002
Practice Address - Street 1:8310 ALLISON POINTE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1981
Practice Address - Country:US
Practice Address - Phone:317-576-0001
Practice Address - Fax:317-576-0002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMPT ADVANCED MANUAL PHYSICAL THERAPY SPECIALTY PT CLINICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty