Provider Demographics
NPI:1083857981
Name:ADVANCED THERAPY INC
Entity Type:Organization
Organization Name:ADVANCED THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-305-5965
Mailing Address - Street 1:863 N COCOA BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7510
Mailing Address - Country:US
Mailing Address - Phone:321-305-5965
Mailing Address - Fax:321-305-5966
Practice Address - Street 1:863 N COCOA BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7510
Practice Address - Country:US
Practice Address - Phone:321-305-5965
Practice Address - Fax:321-305-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency