Provider Demographics
NPI:1699717140
Name:ADVANCED PHYSICAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN BRUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CHT
Authorized Official - Phone:908-276-0237
Mailing Address - Street 1:210 NORTH AVE E
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2441
Mailing Address - Country:US
Mailing Address - Phone:908-276-0237
Mailing Address - Fax:908-276-5692
Practice Address - Street 1:210 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2441
Practice Address - Country:US
Practice Address - Phone:908-276-0237
Practice Address - Fax:908-276-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ031304Medicare ID - Type Unspecified
NJ0802490001Medicare NSC