Provider Demographics
NPI:1396778668
Name:ADVANCED THERAPY CONCEPTS OF BROWARD INC
Entity type:Organization
Organization Name:ADVANCED THERAPY CONCEPTS OF BROWARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:URSO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-478-4648
Mailing Address - Street 1:6530 W. SUNRISE BLVD.
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:954-616-1670
Mailing Address - Fax:954-616-1672
Practice Address - Street 1:6530 W SUNRISE BLVD.
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6037
Practice Address - Country:US
Practice Address - Phone:954-578-6032
Practice Address - Fax:954-530-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 13607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC696Medicare PIN