Organization
ADVANCE PHYSICAL THERAPY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN C. SHAK PT (OWNER)
(610) 253-3300
Entity
Organization
Contact information
Practice address
318 TOWN CENTER BLVD, SUITE A, EASTON, PA 18040-8366
(610) 253-3300
(610) 253-1118
Mailing address
150 CHASE HOLLOW DR, NAZARETH, PA 18064-8104
(610) 746-9432
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT013574L
PA
225100000X
Physical Therapist
PT013653L
PA
225100000X
Physical Therapist
PT016511
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0246801
ORTHONET
PW
01
—
02999500
CAPITAL BLUE CROSS
PA
01
—
2120902000
PERSONAL CHOICE INDEPENDE
PA
01
—
341-9140
AETNA HMO
PA
01
—
5912334
CIGNA
PA
01
—
7618519
AETNA
PA
01
—
7692221
AETNA MANAGED PLAN
PA
01
—
960655
ONE HEALTH PLAN OF PA
PA
01
—
AD1436033
BLUE SHIELD
PA
01
—
DA1820
RAILROAD MEDICARE
PA
01
—
P11192619
MULTIPLAN
PA
01
—
P2607186
OXFORD
PA
Enumeration date
07/08/2006
Last updated
08/22/2020
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