Provider Demographics
NPI:1548682982
Name:ADVANCE PHYSICAL THERAPY INSTITUTE, INC
Entity type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALIXTO
Authorized Official - Middle Name:AGUILAR
Authorized Official - Last Name:AGUDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:501-504-9104
Mailing Address - Street 1:1132 FAWNLILY CIR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8060
Mailing Address - Country:US
Mailing Address - Phone:501-504-9104
Mailing Address - Fax:
Practice Address - Street 1:1132 FAWNLILY CIR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8060
Practice Address - Country:US
Practice Address - Phone:501-504-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-18
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017782225100000X
IL070015817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherIRS