Provider Demographics
NPI:1174679211
Name:THERAPEUTIC ADVANTAGE INCORPORATED
Entity Type:Organization
Organization Name:THERAPEUTIC ADVANTAGE INCORPORATED
Other - Org Name:THERAPEUTIC ADVANTAGE, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:IMPERIAL
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:310-327-9101
Mailing Address - Street 1:19191 S VERMONT AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1018
Mailing Address - Country:US
Mailing Address - Phone:310-327-9101
Mailing Address - Fax:310-327-6611
Practice Address - Street 1:19191 S VERMONT AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1018
Practice Address - Country:US
Practice Address - Phone:310-327-9101
Practice Address - Fax:310-327-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263932251G0304X
CA6118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16201OtherGROUP ID NUMBER