Healthcare Provider Details

I. General information

NPI: 1932339090
Provider Name (Legal Business Name): ADVANCED THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 DEBBIE LN
POPLAR BLUFF MO
63901-2650
US

IV. Provider business mailing address

1901 N WESTWOOD BLVD PRIVATE BOX 113
POPLAR BLUFF MO
63901-2800
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-3966
  • Fax: 573-785-3966
Mailing address:
  • Phone: 573-785-3966
  • Fax: 573-785-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2003020136
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003419
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100740
License Number StateMO

VIII. Authorized Official

Name: MR. DENNIS KEELING
Title or Position: PARTNER
Credential:
Phone: 573-785-3966