Provider Demographics
NPI:1912070046
Name:ADVANCED PHYSICAL THERAPY CENTER
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY-MING
Authorized Official - Middle Name:
Authorized Official - Last Name:OU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:626-576-5757
Mailing Address - Street 1:801 W VALLEY BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3250
Mailing Address - Country:US
Mailing Address - Phone:626-576-5757
Mailing Address - Fax:626-576-5760
Practice Address - Street 1:801 W VALLEY BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3250
Practice Address - Country:US
Practice Address - Phone:626-576-5757
Practice Address - Fax:626-576-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT10943Medicare PIN