Healthcare Provider Details

I. General information

NPI: 1003044009
Provider Name (Legal Business Name): ACTIVE ABILITIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33455 STERLING HIGHWAY
STERLING AK
99672-1118
US

IV. Provider business mailing address

PO BOX 1118
STERLING AK
99672-1118
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-7748
  • Fax: 907-262-7749
Mailing address:
  • Phone: 907-262-7748
  • Fax: 907-262-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number833
License Number StateAK

VIII. Authorized Official

Name: MS. TINA ELAINE MCLEAN
Title or Position: OWNER/SOLE MEMBER
Credential: PHYSICAL THERAPIST
Phone: 907-262-7748