Provider Demographics
NPI:1629499546
Name:ADVANCE THERAPEUTIC CARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ADVANCE THERAPEUTIC CARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:BUENAFLOR
Authorized Official - Last Name:WOO VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:917-485-9695
Mailing Address - Street 1:10015 QUEENS BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2465
Mailing Address - Country:US
Mailing Address - Phone:347-813-4960
Mailing Address - Fax:347-813-4989
Practice Address - Street 1:10015 QUEENS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2465
Practice Address - Country:US
Practice Address - Phone:347-813-4960
Practice Address - Fax:347-813-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032514261QP2000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy