Provider Demographics
NPI:1427054980
Name:ADVANCED PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MCGOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-434-6024
Mailing Address - Street 1:724 W MAIN ST
Mailing Address - Street 2:STE 180
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3583
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:STE 180
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3583
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:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX632910000174400000X
TX532820000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164329801Medicaid
TX181336500OtherDEPARTMENT OF LABOR
TX650019522OtherRAILROAD MEDICARE
TX0095DSOtherBLUECROSSBLUESHIELD OF TX