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Organization

ADVANCED MEDICAL THERAPY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. HADDAR ICHILOV PT (BUSINESS ADMINISTRATOR)
(602) 439-3800
Entity
Organization

Contact information

Practice address
15640 NORTH 7TH STREET, STE 6, PHOENIX, AZ 85022
(602) 439-3800
(602) 439-3802
Mailing address
15640 NORTH 7TH STREET, STE 6, PHOENIX, AZ 85022
(602) 439-3800
(602) 439-3802

Taxonomy

Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
OTC 3834
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
944349
AZ
01
AZ0463990
BLUE CROSS
AZ
Enumeration date
05/18/2006
Last updated
11/28/2011
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