Healthcare Provider Details

I. General information

NPI: 1265898696
Provider Name (Legal Business Name): ADVANCED THERAPY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 AVENUE E STE A
BILLINGS MT
59102-2943
US

IV. Provider business mailing address

1701 AVENUE E STE A
BILLINGS MT
59102-2943
US

V. Phone/Fax

Practice location:
  • Phone: 406-690-6990
  • Fax: 406-206-5262
Mailing address:
  • Phone: 406-690-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: ADEENA JACOBSON
Title or Position: OWNER/CLINICIAN
Credential: BCBA
Phone: 917-882-2744