Provider Demographics
NPI:1386188274
Name:ADVANCED THERAPY INC.
Entity Type:Organization
Organization Name:ADVANCED THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:M,S
Authorized Official - Phone:786-622-7801
Mailing Address - Street 1:6741 SW 24TH ST
Mailing Address - Street 2:SUITE 59
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1762
Mailing Address - Country:US
Mailing Address - Phone:786-622-7801
Mailing Address - Fax:786-536-2764
Practice Address - Street 1:6741 SW 24TH ST
Practice Address - Street 2:SUITE 59
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1762
Practice Address - Country:US
Practice Address - Phone:786-622-7801
Practice Address - Fax:786-536-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12771235Z00000X
FLSA12771261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty