Provider Demographics
NPI:1902971427
Name:ADVANCED PHYSICAL THERAPY OF VENICE INC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY OF VENICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALICA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-493-6449
Mailing Address - Street 1:1232 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4507
Mailing Address - Country:US
Mailing Address - Phone:941-493-6449
Mailing Address - Fax:941-496-4227
Practice Address - Street 1:1232 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4507
Practice Address - Country:US
Practice Address - Phone:941-493-6449
Practice Address - Fax:941-496-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275889OtherAVMED
FL1046759OtherAETNA HMO ONLY
FLY906UOtherBCBS FACILITY GROUP #
FL207105OtherAMERIGROUP
FLY906UOtherBCBS FACILITY GROUP #