Provider Demographics
NPI:1518583038
Name:ADVANCED THERAPY AND PERFORMANCE LLC
Entity type:Organization
Organization Name:ADVANCED THERAPY AND PERFORMANCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:LUCIAN
Authorized Official - Last Name:BOAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:260-255-6494
Mailing Address - Street 1:4106 MERCHANT RD RM A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-1248
Mailing Address - Country:US
Mailing Address - Phone:260-255-6494
Mailing Address - Fax:260-399-2075
Practice Address - Street 1:3630 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2062
Practice Address - Country:US
Practice Address - Phone:260-255-6494
Practice Address - Fax:260-399-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty