Provider Demographics
NPI:1134194749
Name:ARIZONA ADVANCED THERAPY, LLC
Entity type:Organization
Organization Name:ARIZONA ADVANCED THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RUTH NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMALANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:480-577-7941
Mailing Address - Street 1:914 E MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8111
Mailing Address - Country:US
Mailing Address - Phone:480-577-7941
Mailing Address - Fax:480-413-9761
Practice Address - Street 1:914 E MONTEREY ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8111
Practice Address - Country:US
Practice Address - Phone:480-577-7941
Practice Address - Fax:480-413-9761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty