NPIMap

Organization Active NPI

Advanced PT, LLC

Doing business as Advanced PT Legacy Park

  • Physical Therapist
  • Wichita, KS
National Provider Identifier
1356645071
Registry record updated Mar 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11-03843 Issued in KS
Legal business name
ADVANCED PT, LLC
Doing business as
Advanced PT Legacy Park
Practice address
2081 N Webb Rd
Wichita, KS 67206-3411
Phone
(316) 269-1311
Fax
(316) 269-1588
NPI assigned
Jan 10, 2011
Last updated
Mar 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David C. Todd, MPTNPI 1992730204
Title
Owner
Phone
(316) 263-0003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Physical Therapist 225100000X 11-03843 KS Primary

Addresses

Primary practice location

2081 N Webb Rd
Wichita, KS 67206-3411

Mailing address

200 W Douglas Ave
Ste 1040
Wichita, KS 67202-3013
Phone (316) 263-0003

Other names 1

  • Advanced PT Legacy Park Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060222000723 KS Part B Supplier - Clinic/Group Practice 3678524709 Receives reassigned benefits from 102 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arkansas City, KS; Andover, KS; Winfield, KS; Wichita, KS; Wellington, KS; Sterling, KS; Park City, KS; Newton, KS…

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

National Provider Directory

National Provider Directory

Locations

3730 N Ridge Rd
Ste 500
Wichita, KS 67205
Phone (316) 440-4901

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393977600000",
    "number": "1356645071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE",
            "address_2": "STE 1040",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023013",
            "telephone_number": "316-263-0003",
            "fax_number": "316-263-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2081 N WEBB RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063411",
            "telephone_number": "316-269-1311",
            "fax_number": "316-269-1588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-10",
        "last_updated": "2014-03-05",
        "status": "A",
        "authorized_official_last_name": "TODD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-263-0003",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-03843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced PT Legacy Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.