Provider Demographics
NPI:1750502225
Name:ADVANCE THERAPY
Entity Type:Organization
Organization Name:ADVANCE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:870-998-2530
Mailing Address - Street 1:8544 GURLEY FARM RD
Mailing Address - Street 2:
Mailing Address - City:BISCOE
Mailing Address - State:AR
Mailing Address - Zip Code:72017-9733
Mailing Address - Country:US
Mailing Address - Phone:870-998-2530
Mailing Address - Fax:
Practice Address - Street 1:1116 N NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-2126
Practice Address - Country:US
Practice Address - Phone:870-734-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160299742Medicaid