Provider Demographics
NPI:1316515422
Name:ADVANCED THERAPY INC.
Entity type:Organization
Organization Name:ADVANCED THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-622-7801
Mailing Address - Street 1:6741 SW 24TH ST STE 59
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1768
Mailing Address - Country:US
Mailing Address - Phone:786-622-7801
Mailing Address - Fax:
Practice Address - Street 1:16650 N KENDALL DR STE 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1283
Practice Address - Country:US
Practice Address - Phone:786-622-7801
Practice Address - Fax:786-536-2764
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED THERAPY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-15
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019488800Medicaid