Provider Demographics
NPI:1386978591
Name:ADVANCED PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-434-6024
Mailing Address - Street 1:724 W MAIN ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3514
Mailing Address - Country:US
Mailing Address - Phone:972-434-6024
Mailing Address - Fax:972-434-2784
Practice Address - Street 1:724 W MAIN ST
Practice Address - Street 2:SUITE 180
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3514
Practice Address - Country:US
Practice Address - Phone:972-434-6024
Practice Address - Fax:972-434-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164329801Medicaid