Organization
ADVANCED THERAPY CLINIC, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY ZIMMERMAN (CLINIC DIRECTOR)
(386) 299-3765
Entity
Organization
Contact information
Practice address
255 S. YONGE ST, ORMOND BEACH, FL 32174
(386) 299-3765
(386) 672-8351
Mailing address
255 S. YONGE ST, ORMOND BEACH, FL 32174
(386) 299-3765
(386) 672-8351
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA30567
FL
Other
Enumeration date
06/01/2007
Last updated
10/09/2012
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