Healthcare Provider Details

I. General information

NPI: 1134636392
Provider Name (Legal Business Name): ACT PHYSICAL THERAPY , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14899 TAMIAMI TRL
NORTH PORT FL
34287-2732
US

IV. Provider business mailing address

15 APEX DR
HIGHLAND IL
62249-1282
US

V. Phone/Fax

Practice location:
  • Phone: 618-651-0444
  • Fax:
Mailing address:
  • Phone: 618-441-0482
  • 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: MICHAEL MCINTOSH
Title or Position: OWNER
Credential:
Phone: 417-773-2157