Provider Demographics
NPI:1710187737
Name:ADVANCE THERAPY PC
Entity Type:Organization
Organization Name:ADVANCE THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OFFICE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-774-9958
Mailing Address - Street 1:3700 CROSS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4137
Mailing Address - Country:US
Mailing Address - Phone:979-774-9958
Mailing Address - Fax:979-774-9978
Practice Address - Street 1:3700 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4137
Practice Address - Country:US
Practice Address - Phone:979-774-9958
Practice Address - Fax:979-774-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00657EMedicare PIN