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General NPI Number Information
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NPI Number | 1356998637
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Entity Type | Organization
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Legal Business Name | ADVANCED CHILDRENS THERAPY INC
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 02/26/2023
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Provider Practice Location Address
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Address Line | 2119 10TH AVE N
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City | LAKE WORTH BEACH
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State | FL
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Zip | 33461-3345
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Country | US
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Telephone | 561-629-6882
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Fax | 561-828-3102
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Provider Business Mailing Address
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Address Line | 2119 10TH AVE N
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City | LAKE WORTH BEACH
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State | FL
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Zip | 33461-3345
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Country | US
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Telephone | 561-629-6882
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Fax | 561-828-3102
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARLYE GONZALEZ ALFONSO
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Credential |
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Telephone | 561-260-1316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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