Healthcare Provider Details

I. General information

NPI: 1558736579
Provider Name (Legal Business Name): ADVANCED CHILDREN'S THEPAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 10TH AVE N SUITE 2119
LAKE WORTH FL
33461-3345
US

IV. Provider business mailing address

2121 10TH AVE N SUITE 2119
LAKE WORTH FL
33461-3345
US

V. Phone/Fax

Practice location:
  • Phone: 561-629-6882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLYE RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 561-629-6882