MEDICARE: ADVANCED ARM DYNAMICS OF TEXAS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	554860000	TX
2	335E00000X	Prosthetic/Orthotic Supplier	000119	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101220	OTHER	TX	STATE FACILITY LICENSE
2	554860000	OTHER	TX	OCCUPATIONAL THERAPY

General Provider Information

NPI Number	:	1871596270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ARM DYNAMICS OF TEXAS, LLC

Provider Business Mailing Address
First Line	:	123 W TORRANCE BLVD
Second Line	:	SUITE 203
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3610
Country	:	US
Telephone Number	:	310-372-3050
Fax Number	:	310-372-3057

Provider Business Practice Location Address
First Line	:	3501 N MACARTHUR BLVD
Second Line	:	SUITE 650
City	:	IRVING
State	:	TX
Zip	:	75062-3636
Country	:	US
Telephone Number	:	214-260-3197
Fax Number	:	214-260-8602

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN MIGUELEZ
Credential	:	CP, FAAOP (D)
Telephone Number	:	310-372-3050

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/16/2025

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