Provider Demographics
NPI:1861528994
Name:ADVANCE PHYSICAL THERAPY AND WELLNESS INC
Entity type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:727-532-1900
Mailing Address - Street 1:13830 58TH ST N
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3720
Mailing Address - Country:US
Mailing Address - Phone:727-532-1900
Mailing Address - Fax:727-532-4300
Practice Address - Street 1:13830 58TH ST N
Practice Address - Street 2:SUITE 409
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3720
Practice Address - Country:US
Practice Address - Phone:727-532-1900
Practice Address - Fax:727-532-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14584225100000X
FLPT17873225100000X
FLPTA1158225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7640AMedicare ID - Type UnspecifiedPROVIDER NUMBER
FLU4188AMedicare ID - Type UnspecifiedPROVIDER NUMBER
FLK7124Medicare ID - Type UnspecifiedGROUP NUMBER
FLP88484Medicare UPIN