Provider Demographics
NPI:1093221616
Name:AVANTI THERAPY GROUP, PSC
Entity Type:Organization
Organization Name:AVANTI THERAPY GROUP, PSC
Other - Org Name:AVANTI THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUSHANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:787-438-6170
Mailing Address - Street 1:675 STREET SC BUSTAMANTE APT 116
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-438-6170
Mailing Address - Fax:
Practice Address - Street 1:500 ALTURAS DE FLAMBOYAN PLAZA CHEVRES
Practice Address - Street 2:AVE TENIENTE NELSON MARTINEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0095
Practice Address - Country:US
Practice Address - Phone:787-438-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty