Organization
ADVANTAGE PHYSICAL THERAPY ASSOCIATES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES A DALLAS LPT (PRESIDENT)
(630) 792-9790
Entity
Organization
Contact information
Practice address
6234 MAIN ST, DOWNERS GROVE, IL 60516-1908
(630) 960-9914
Mailing address
PO BOX 72180, ROSELLE, IL 60172-0180
(630) 792-9790
(630) 792-9794
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-002882
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164680492
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/22/2008
Last updated
03/04/2009
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