Healthcare Provider Details

I. General information

NPI: 1184592594
Provider Name (Legal Business Name): PROACTIVE PHYSICAL THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 E. GREEN ST. APT 1441
PASADENA CA
91101-4418
US

IV. Provider business mailing address

275 E. GREEN ST. APT 1441
PASADENA CA
91101-4418
US

V. Phone/Fax

Practice location:
  • Phone: 772-924-4283
  • Fax:
Mailing address:
  • Phone: 772-924-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW JASON GUTHART
Title or Position: OWNER
Credential:
Phone: 772-924-4283