=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982878401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED THERAPY CARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2008
-----------------------------------------------------
Last Update Date | 07/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 N 3RD E BOX 603
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83647-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-587-8255
-----------------------------------------------------
Fax | 208-587-5734
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 N 3RD E BOX 603
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83647-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-587-8255
-----------------------------------------------------
Fax | 208-587-5734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | RACHELLE OWSLEY RUFFING
-----------------------------------------------------
Credential | MS CCC SLP
-----------------------------------------------------
Telephone | 208-587-8255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP1211
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------