Healthcare Provider Details

I. General information

NPI: 1538199435
Provider Name (Legal Business Name): ADVANCED MEDICAL THERAPY INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6776 54TH AVE N SUITE B
ST PETERSBURG FL
33709-1405
US

IV. Provider business mailing address

6776 54TH AVE N SUITE B
ST PETERSBURG FL
33709-1405
US

V. Phone/Fax

Practice location:
  • Phone: 727-397-9118
  • Fax: 727-397-9440
Mailing address:
  • Phone: 727-397-9118
  • Fax: 727-397-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JOE DISTEFANO
Title or Position: OWNER
Credential:
Phone: 727-397-9118