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General NPI Number Information
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NPI Number | 1215448154
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Entity Type | Organization
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Legal Business Name | ADVANCE THERAPEUTIC LLC
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 6910 STIRLING RD
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City | DAVIE
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-388-8363
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Fax | 888-363-4862
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Provider Business Mailing Address
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Address Line | 6910 STIRLING RD
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City | DAVIE
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-388-8363
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Fax | 888-363-4862
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. MICHAEL A SURO
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Credential |
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Telephone | 954-388-8363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | FL
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