Provider Demographics
NPI:1588143952
Name:ADVANCED PHYSIQUE SOLUTIONS, LLC
Entity type:Organization
Organization Name:ADVANCED PHYSIQUE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL EXERCISE PHYSIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:RCEP
Authorized Official - Phone:347-682-1894
Mailing Address - Street 1:920 WESTCOTT ST APT 507
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-6367
Mailing Address - Country:US
Mailing Address - Phone:347-682-1894
Mailing Address - Fax:
Practice Address - Street 1:920 WESTCOTT ST. #507
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-7700
Practice Address - Country:US
Practice Address - Phone:347-682-1894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74234673224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty