Provider Demographics
NPI:1477786358
Name:ADVANCED THERAPY CARE PLLC
Entity Type:Organization
Organization Name:ADVANCED THERAPY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:OWSLEY
Authorized Official - Last Name:RUFFING
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:208-587-8255
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:245 NORTH THIRD EAST AVE.
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-0603
Mailing Address - Country:US
Mailing Address - Phone:208-587-8255
Mailing Address - Fax:208-587-4475
Practice Address - Street 1:245 N 3RD E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2734
Practice Address - Country:US
Practice Address - Phone:208-587-8255
Practice Address - Fax:208-587-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP1211261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech