Provider Demographics
NPI:1861571077
Name:ADVANTAGE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRANSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-244-0115
Mailing Address - Street 1:6512 WESTSIDE RD STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-4868
Mailing Address - Country:US
Mailing Address - Phone:530-224-0115
Mailing Address - Fax:530-224-0149
Practice Address - Street 1:6512 WESTSIDE RD
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-4868
Practice Address - Country:US
Practice Address - Phone:530-224-0115
Practice Address - Fax:530-224-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04420ZMedicare PIN
CA0PT119021Medicare PIN
CA6401140001Medicare NSC