Provider Demographics
NPI:1982878401
Name:ADVANCED THERAPY CARE, PLLC
Entity type:Organization
Organization Name:ADVANCED THERAPY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:OWSLEY
Authorized Official - Last Name:RUFFING
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:208-587-8255
Mailing Address - Street 1:245 N 3RD E
Mailing Address - Street 2:BOX 603
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2734
Mailing Address - Country:US
Mailing Address - Phone:208-587-8255
Mailing Address - Fax:208-587-5734
Practice Address - Street 1:245 N 3RD E
Practice Address - Street 2:BOX 603
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2734
Practice Address - Country:US
Practice Address - Phone:208-587-8255
Practice Address - Fax:208-587-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP1211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty