Basic Information
| Provider Information | |||||||||
| NPI: | 1154331262 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PHYSICAL THERAPY CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 392573 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152519500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243434060 | ||||||||
| FaxNumber: | 7243434069 | ||||||||
| Practice Location | |||||||||
| Address1: | 10809 S SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484397029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106958700 | ||||||||
| FaxNumber: | 8106957946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | LAU | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7249894564 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000455 | 01 | MI | THERAMATRIX PROV ID NO. | OTHER | 000261F7 | 01 | MI | HAP PROVIDER ID NO. | OTHER | 5849317 | 01 | MI | CIGNA PROVIDER ID NO. | OTHER | 0141732 | 01 | MI | HEALTHPLUS PROV ID NO. | OTHER | 109526 | 01 | MI | PREF CHOICES PPO PRV ID # | OTHER | 30367 | 01 | MI | BLUE CROSS/BCN PROV ID # | OTHER | 4716268/40 | 05 | MI | MEDICAID | RT250002 | 01 | MI | M-CARE PROVIDER ID NO. | OTHER | 1011271 | 01 | MI | HLTH ADVANTAGE PROV ID # | OTHER | 4669970 | 01 | MI | AETNA PROVIDER ID NO. | OTHER |