Provider Demographics
NPI:1265078596
Name:ADVANCED PHYSICAL THERAPY TO GO LLC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY TO GO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-239-8925
Mailing Address - Street 1:12112 TOPEKA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5020 122ND STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8398
Practice Address - Country:US
Practice Address - Phone:806-705-7239
Practice Address - Fax:806-370-6536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4088940Medicaid