Provider Demographics
NPI:1932339090
Name:ADVANCED THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-785-3966
Mailing Address - Street 1:1901 N WESTWOOD BLVD
Mailing Address - Street 2:PRIVATE BOX 113
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2800
Mailing Address - Country:US
Mailing Address - Phone:573-785-3966
Mailing Address - Fax:573-785-3966
Practice Address - Street 1:2702 DEBBIE LN
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2650
Practice Address - Country:US
Practice Address - Phone:573-785-3966
Practice Address - Fax:573-785-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003020136225100000X
MO003419225X00000X
MO100740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty