NPIMap

Organization Active NPI

Advance Physical Therapy & Sports Medicine of Lebanon, LLC

  • Physical Therapist
  • Lebanon, MO
National Provider Identifier
1356669220
Registry record updated May 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ADVANCE PHYSICAL THERAPY & SPORTS MEDICINE OF LEBANON, LLC
Practice address
144 Evergreen Parkway
Lebanon, MO 65536-0000
Phone
(217) 222-6800
Fax
(217) 222-0037
NPI assigned
May 17, 2010
Last updated
May 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2010

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

Authorized official

Name
Gregory Reis, PTNPI 1972519171
Title
Partner
Phone
(217) 222-6800

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

144 Evergreen Parkway
Lebanon, MO 65536-0000

Mailing address

144 Evergreen Parkway
Lebanon, MO 65536-0000
Phone (217) 222-6800

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1274054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1356669220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 EVERGREEN PARKWAY",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655360000",
            "telephone_number": "217-222-6800",
            "fax_number": "217-222-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 EVERGREEN PARKWAY",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655360000",
            "telephone_number": "217-222-6800",
            "fax_number": "217-222-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE PHYSICAL THERAPY & SPORTS MEDICINE OF LEBANON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-17",
        "last_updated": "2010-05-17",
        "status": "A",
        "authorized_official_last_name": "REIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "217-222-6800",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.