Provider Demographics
NPI:1215109202
Name:ADVANCED THERAPY NOW INC
Entity type:Organization
Organization Name:ADVANCED THERAPY NOW INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KALYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:505-573-4472
Mailing Address - Street 1:2012 WHITE CLOUD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3717
Mailing Address - Country:US
Mailing Address - Phone:505-573-4472
Mailing Address - Fax:505-212-0521
Practice Address - Street 1:1024 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5310
Practice Address - Country:US
Practice Address - Phone:505-573-4472
Practice Address - Fax:505-212-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96187328Medicaid