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General NPI Number Information
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NPI Number | 1073837522
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Entity Type | Organization
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Legal Business Name | ADVANCED TOTAL THERAPY, INC
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 1100 N MAIN ST STE B
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City | BELLE GLADE
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State | FL
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Zip | 33430-1973
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Country | US
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Telephone | 561-993-3301
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Fax | 561-993-3304
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Provider Business Mailing Address
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Address Line | 1100 N MAIN ST STE B
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City | BELLE GLADE
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State | FL
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Zip | 33430-1973
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Country | US
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Telephone | 561-993-3301
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Fax | 561-993-3304
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CARMENCITA WALLS
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Credential | PT
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Telephone | 561-340-9936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT20447
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License Number State | FL
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