Provider Demographics
NPI:1811150774
Name:ADVANCE THERAPY GROUP PSC
Entity type:Organization
Organization Name:ADVANCE THERAPY GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-948-2866
Mailing Address - Street 1:HC 1 BOX 26910
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8933
Mailing Address - Country:US
Mailing Address - Phone:787-948-2866
Mailing Address - Fax:787-737-6493
Practice Address - Street 1:STREET 189 MARINA PLAZA
Practice Address - Street 2:SUITE 17-18
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-948-2866
Practice Address - Fax:787-737-6493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR824235Z00000X
PR983225X00000X
PR763224Z00000X
PR1449-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty