Provider Demographics
NPI:1447294228
Name:ADVANCED PHYSICAL THERAPY OF FAYETTE
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY OF FAYETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:YOLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-460-6285
Mailing Address - Street 1:135 BRANDYWINE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1590
Mailing Address - Country:US
Mailing Address - Phone:770-460-6285
Mailing Address - Fax:770-460-6512
Practice Address - Street 1:135 BRANDYWINE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1590
Practice Address - Country:US
Practice Address - Phone:770-460-6285
Practice Address - Fax:770-460-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006402261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS73576Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER