Provider Demographics
NPI:1518982404
Name:ADVANCE THERAPEUTICS, INC.
Entity type:Organization
Organization Name:ADVANCE THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:413-584-7234
Mailing Address - Street 1:16 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WEST HATFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01088-9515
Mailing Address - Country:US
Mailing Address - Phone:413-247-6471
Mailing Address - Fax:413-247-6474
Practice Address - Street 1:16 WEST ST
Practice Address - Street 2:
Practice Address - City:WEST HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01088
Practice Address - Country:US
Practice Address - Phone:413-247-6471
Practice Address - Fax:413-247-6474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA805420OtherTUFTS
MAY65630OtherBLUE CROSS OF MA
MA805420OtherTUFTS