Provider Demographics
NPI:1194360768
Name:ADVANT THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ADVANT THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-822-8487
Mailing Address - Street 1:4827 OLD NATIONAL HWY
Mailing Address - Street 2:PMB 1619
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4827 OLD NATIONAL HWY
Practice Address - Street 2:PMB 1619
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337
Practice Address - Country:US
Practice Address - Phone:732-822-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty