Healthcare Provider Details

I. General information

NPI: 1073369849
Provider Name (Legal Business Name): ACTIVE MOBILE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 CENTER ST
REDDING CA
96001-0617
US

IV. Provider business mailing address

3477 FOOTBRIDGE CT
REDDING CA
96003-2184
US

V. Phone/Fax

Practice location:
  • Phone: 530-768-8745
  • Fax:
Mailing address:
  • Phone: 530-739-3833
  • Fax: 530-418-0944

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: DR. CHRISTIAN MEYER MERCILL
Title or Position: OWNER/CEO
Credential: DPT
Phone: 530-739-3833