# ADVANCE PEDIATRIC & ADULT THERAPY,LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053528869
- **Authorized official:** MS. DEBRA G KOON PT,ATC (PRESIDENT)
- **Authorized official phone:** (205) 349-0995

## Contact information

- **Practice address:** 15631 QUAIL PT, NORTHPORT, AL 35475-2614
- **Practice address phone:** (205) 349-0995
- **Practice address fax:** (205) 349-0995
- **Mailing address:** PO BOX 20429, TUSCALOOSA, AL 35402-0429
- **Mailing address phone:** (205) 349-0995
- **Mailing address fax:** (205) 349-0995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 05/17/2007
- **Last updated:** 08/22/2020