Basic Information
| Provider Information | |||||||||
| NPI: | 1376522540 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVANTE PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 SW CARY PKWY | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275116219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194639443 | ||||||||
| FaxNumber: | 9194639466 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 SW CARY PKWY | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275116219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194639443 | ||||||||
| FaxNumber: | 9194639466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | REEVES | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9194639443 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 012AM | 01 | NC | BCBSNC | OTHER |