Healthcare Provider Details

I. General information

NPI: 1780959718
Provider Name (Legal Business Name): ADVANCE THERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N KINGS HWY SUITE 101
CHERRY HILL NJ
08034-1906
US

IV. Provider business mailing address

1020 N KINGS HWY SUITE 101
CHERRY HILL NJ
08034-1906
US

V. Phone/Fax

Practice location:
  • Phone: 856-330-4360
  • Fax: 856-330-4281
Mailing address:
  • Phone: 856-330-4360
  • Fax: 856-330-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANURAG TRIPATHI
Title or Position: PRESIDENT
Credential: OTRL
Phone: 856-330-4360