Healthcare Provider Details

I. General information

NPI: 1679518328
Provider Name (Legal Business Name): ACTIVE THERAPY ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7911 NW 72ND AVE STE 204
MEDLEY FL
33166-2227
US

IV. Provider business mailing address

7911 NW 72ND AVE STE 204
MEDLEY FL
33166-2227
US

V. Phone/Fax

Practice location:
  • Phone: 305-883-7859
  • Fax: 305-885-6301
Mailing address:
  • Phone: 305-883-7859
  • Fax: 305-885-6301

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: RONALD ASSEE
Title or Position: PRESIDENT
Credential: OT
Phone: 305-883-7859