Provider Demographics
NPI:1730358839
Name:ADVANCE THERAPY SERVICES, INC
Entity type:Organization
Organization Name:ADVANCE THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANURAG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPATHI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:856-642-4028
Mailing Address - Street 1:309 FELLOWSHIP RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1234
Mailing Address - Country:US
Mailing Address - Phone:856-642-4028
Mailing Address - Fax:856-267-5025
Practice Address - Street 1:309 FELLOWSHIP RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1234
Practice Address - Country:US
Practice Address - Phone:856-642-4028
Practice Address - Fax:856-267-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ159720Medicare PIN