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General NPI Number Information
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NPI Number | 1619204336
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Entity Type | Organization
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Legal Business Name | ADVANCED THERAPY SOLUTIONS, LLC
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 7006 HARVEST GOLD WAY APT 3
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City | LOUISVILLE
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State | KY
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Zip | 40291-5757
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Country | US
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Telephone | 859-582-7593
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Fax | 859-455-9502
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Provider Business Mailing Address
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Address Line | 7006 HARVEST GOLD WAY APT 3
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City | LOUISVILLE
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State | KY
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Zip | 40291-5757
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Country | US
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Telephone | 859-582-7593
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Fax | 859-455-9502
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Authorized Official
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Title or Position | CO-OWNER
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Name | SAMANTHA J MULLINS
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Credential | LMT
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Telephone | 859-582-7593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | KY-2536
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License Number State | KY
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