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General NPI Number Information
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NPI Number | 1295027589
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Entity Type | Organization
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Legal Business Name | ADVANCE THERAPY ASSOCIATES
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 590 MIDDLEBURY RD
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City | MIDDLEBURY
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State | CT
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Zip | 06762-2562
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Country | US
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Telephone | 203-577-3700
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Fax | 203-577-3800
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Provider Business Mailing Address
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Address Line | 590 MIDDLEBURY RD
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City | MIDDLEBURY
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State | CT
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Zip | 06762-2562
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Country | US
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Telephone | 203-577-3700
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Fax | 203-577-3800
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Authorized Official
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Title or Position | CEO
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Name | FILOMENA RINALDI
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Credential |
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Telephone | 203-577-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 003769
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License Number State | CT
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