Organization · NPI-2

Advanta Medical & Physical Therapy PC

General Practice · Marietta, GA

NPI number1609158096
StatusActive
Last updated in NPPESNov 21, 2012

Details

NPI
1609158096
Entity type
Organization (NPI-2)
Legal business name
Advanta Medical & Physical Therapy PC
Organization subpart
No
Enumeration date
Sep 13, 2011
Last updated
Nov 21, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208D00000X General Practice––Yes
225100000X Physical Therapist––
111N00000X Chiropractor–GA
207R00000X Internal Medicine–GA

Other names

  • Advanta Total Health (Doing Business As)

Practice location

1720 Powers Ferry Rd
Suite 100
Marietta, GA 30067-5442

Phone 770-955-2225 · Fax 770-953-6658

Mailing address

1720 Powers Ferry Rd
Suite 100
Marietta, GA 30067-5442

Phone 770-955-2225 · Fax 770-953-6658

Authorized official

Richard Philip Schuyler
President
7709552225

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