Basic Information
Provider Information
NPI: 1295929644
EntityType: 2
ReplacementNPI:  
OrganizationName: APEX PHYSICAL THERAPY, LLC
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Mailing Information
Address1: 15 APEX DR
Address2:  
City: HIGHLAND
State: IL
PostalCode: 622491282
CountryCode: US
TelephoneNumber: 6186510444
FaxNumber: 6186545439
Practice Location
Address1: 884 WOODS MILL RD STE 200
Address2:  
City: BALLWIN
State: MO
PostalCode: 630113657
CountryCode: US
TelephoneNumber: 6362384910
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/29/2007
LastUpdateDate: 09/02/2021
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: PFITZNER
AuthorizedOfficialFirstName: BRADLEY
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: CEO PRESIDENT
AuthorizedOfficialTelephone: 6186510444
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: OTR L
NPICertificationDate: 09/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QX0100X  N Ambulatory Health Care FacilitiesClinic/CenterOccupational Medicine
261QP2000X  Y Ambulatory Health Care FacilitiesClinic/CenterPhysical Therapy

No ID Information.


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