Provider Demographics
NPI:1487984951
Name:ADVANCED PHYSICAL THERAPY,LLC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:EMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:864-343-2650
Mailing Address - Street 1:PO BOX 2225
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-2225
Mailing Address - Country:US
Mailing Address - Phone:864-343-2650
Mailing Address - Fax:864-343-2680
Practice Address - Street 1:115 BRUSHY CREEK RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1120
Practice Address - Country:US
Practice Address - Phone:864-343-2650
Practice Address - Fax:864-343-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9429OtherMEDICARE GROUP PTAN