Provider Demographics
NPI:1376756619
Name:ADVANCED THERAPY SOLUTIONS INC
Entity Type:Organization
Organization Name:ADVANCED THERAPY SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:407-788-7515
Mailing Address - Street 1:385 DOUGLAS AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3339
Mailing Address - Country:US
Mailing Address - Phone:407-788-7515
Mailing Address - Fax:407-788-3450
Practice Address - Street 1:385 DOUGLAS AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3339
Practice Address - Country:US
Practice Address - Phone:407-788-7515
Practice Address - Fax:407-788-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM15195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL746Medicare PIN