Provider Demographics
NPI:1912252651
Name:ADVANCED THERAPY SOLUTIONS
Entity Type:Organization
Organization Name:ADVANCED THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPY PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L, BSRS
Authorized Official - Phone:1815-218-3618
Mailing Address - Street 1:2711 EDELWEISS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-2406
Mailing Address - Country:US
Mailing Address - Phone:181-521-8361
Mailing Address - Fax:
Practice Address - Street 1:7264 ARGUS DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5837
Practice Address - Country:US
Practice Address - Phone:181-563-3681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05600853261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation