Provider Demographics
NPI:1255350443
Name:ADVANCE THERAPY INC
Entity type:Organization
Organization Name:ADVANCE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HOWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:321-795-5756
Mailing Address - Street 1:5266 MANSFORD PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1241
Mailing Address - Country:US
Mailing Address - Phone:321-795-5756
Mailing Address - Fax:321-253-2951
Practice Address - Street 1:5266 MANSFORD PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1241
Practice Address - Country:US
Practice Address - Phone:321-795-5756
Practice Address - Fax:321-253-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty