Provider Demographics
NPI:1265733794
Name:ADVANCED THERAPY ASSOCIATES, INC.
Entity type:Organization
Organization Name:ADVANCED THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:YALE
Authorized Official - Last Name:MALMQUIST
Authorized Official - Suffix:III
Authorized Official - Credentials:MSPT
Authorized Official - Phone:928-920-6600
Mailing Address - Street 1:6319 E TELEGRAPH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-1117
Mailing Address - Country:US
Mailing Address - Phone:928-920-6600
Mailing Address - Fax:928-344-6699
Practice Address - Street 1:6319 E TELEGRAPH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1117
Practice Address - Country:US
Practice Address - Phone:928-920-6600
Practice Address - Fax:928-344-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health