1St Advantage Physical Therapy PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

05005012A Issued in IN

Legal business name

1ST ADVANTAGE PHYSICAL THERAPY PC

Practice address

1516 N Main St
Crown Point, IN 46307-2332

Phone

(219) 226-1500

Fax

(219) 226-0500

NPI assigned

Dec 7, 2007

Last updated

Jan 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Elo, PT

Title

President

Phone

(219) 663-3554

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200960000000",
    "number": "1962685388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 N MAIN ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463072332",
            "telephone_number": "219-226-1500",
            "fax_number": "219-226-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 N MAIN ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463072332",
            "telephone_number": "219-226-1500",
            "fax_number": "219-226-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST ADVANTAGE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-07",
        "last_updated": "2008-01-22",
        "status": "A",
        "authorized_official_last_name": "ELO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-663-3554",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IN",
            "license": "05005012A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000363591",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00374932",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 1St Kids, Inc
• 219 Health Network, Inc.
• 219 Health Network, Inc.
• 219 Health Network, Inc.
• A&E Diagnostic Imaging, LLC

• Physical Medicine & Rehabilitation Physician in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Physical Medicine & Rehabilitation Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; 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.