Healthcare Provider Details

I. General information

NPI: 1932781689
Provider Name (Legal Business Name): ACTIVE PHYSICAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 OPAL CT STE 306
HAGERSTOWN MD
21740-5941
US

IV. Provider business mailing address

PO BOX 419666
BOSTON MA
02241-9666
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-3929
  • Fax:
Mailing address:
  • Phone: 410-970-8190
  • 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: TERRY PAUL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 410-970-8190