Provider Demographics
NPI:1053528869
Name:ADVANCE PEDIATRIC & ADULT THERAPY,LLC.
Entity type:Organization
Organization Name:ADVANCE PEDIATRIC & ADULT THERAPY,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOON
Authorized Official - Suffix:
Authorized Official - Credentials:PT,ATC
Authorized Official - Phone:205-349-0995
Mailing Address - Street 1:PO BOX 20429
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35402-0429
Mailing Address - Country:US
Mailing Address - Phone:205-349-0995
Mailing Address - Fax:205-349-0995
Practice Address - Street 1:15631 QUAIL PT
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-2614
Practice Address - Country:US
Practice Address - Phone:205-349-0995
Practice Address - Fax:205-349-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty