Provider Demographics
NPI:1992933709
Name:ADVANCED PHYSICAL THERAPY & REHAB SERVICES INC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY & REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINODH
Authorized Official - Middle Name:VADAKKEDATHU
Authorized Official - Last Name:RAVINDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHSPT
Authorized Official - Phone:317-652-5043
Mailing Address - Street 1:3833 PARADE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5544
Mailing Address - Country:US
Mailing Address - Phone:317-652-5043
Mailing Address - Fax:
Practice Address - Street 1:781 WEATHERLY DR
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8953
Practice Address - Country:US
Practice Address - Phone:317-652-5043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8359261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy