Provider Demographics
NPI:1679875447
Name:ADVANCE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:ADVANCE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:901-428-3445
Mailing Address - Street 1:1290 PINNACLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1364
Mailing Address - Country:US
Mailing Address - Phone:901-428-3445
Mailing Address - Fax:901-854-9261
Practice Address - Street 1:2597 AVERY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4818
Practice Address - Country:US
Practice Address - Phone:901-416-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3164251300000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency