Provider Demographics
NPI:1023438348
Name:ADVANCE THERAPY WORKS INC.
Entity type:Organization
Organization Name:ADVANCE THERAPY WORKS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:305-378-5247
Mailing Address - Street 1:12060 SW 129TH CT
Mailing Address - Street 2:SUITE #107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4581
Mailing Address - Country:US
Mailing Address - Phone:305-378-5247
Mailing Address - Fax:305-378-6760
Practice Address - Street 1:12060 SW 129TH CT
Practice Address - Street 2:SUITE #107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4581
Practice Address - Country:US
Practice Address - Phone:305-378-5247
Practice Address - Fax:305-378-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12714224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty