| Organization Name: | ADVANCED THERAPY CLINIC, L.L.C. |
| NPI Number: | 1912109927 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDY ZIMMERMAN (CLINIC DIRECTOR) |
| Mailing Address: | 255 S. Yonge St Ormond Beach |
| State: | FL US |
| Postal Code: | 32174 |
| Phone Number: | 3862993765 |
| Fax Number: | 3866728351 |
| NPI Enumeration Date: | 06/01/2007 |
| NPI Last Update Date: | 10/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171W00000X |
| License Number: | MA30567 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |