Provider Demographics
NPI:1649483785
Name:ADVANCED THERAPEUTICS & MASSAGE INC
Entity type:Organization
Organization Name:ADVANCED THERAPEUTICS & MASSAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-750-0678
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34492-1086
Mailing Address - Country:US
Mailing Address - Phone:352-750-0678
Mailing Address - Fax:352-750-0523
Practice Address - Street 1:13690 US HWY 441
Practice Address - Street 2:STE 300
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-750-0678
Practice Address - Fax:352-750-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7261OtherBLUE CROSS BLUE SHIELD