MEDICARE: AKTIVE MOTION PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	261QR0400X	Rehabilitation Clinic/Center	PT30933	FL
3	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)
4	261QR0800X	Recovery Care Clinic/Center
5	261QH0100X	Health Service Clinic/Center
6	261QP3300X	Pain Clinic/Center
7	261QR0400X	Rehabilitation Clinic/Center
8	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710482948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKTIVE MOTION PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	343 5TH ST SW
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34117-2113
Country	:	US
Telephone Number	:	239-672-0174
Fax Number	:	239-307-4116

Provider Business Practice Location Address
First Line	:	4766 GOLDEN GATE PKWY STE 4
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-6935
Country	:	US
Telephone Number	:	239-280-0368
Fax Number	:	239-307-4116

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	JEAN DANIEL DORNEVIL
Credential	:	PT., DPT
Telephone Number	:	239-672-0174

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	08/19/2024

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Directions to “AKTIVE MOTION PHYSICAL THERAPY INC ” Practice Location

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