Healthcare Provider Details

I. General information

NPI: 1295610525
Provider Name (Legal Business Name): ACTIVE CARE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25932 DEQUINDRE RD STE B
WARREN MI
48091-1071
US

IV. Provider business mailing address

PO BOX 1386
STERLING HEIGHTS MI
48311-1386
US

V. Phone/Fax

Practice location:
  • Phone: 586-256-3725
  • Fax:
Mailing address:
  • Phone:
  • 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: LINA ANKAWI
Title or Position: OWNER
Credential:
Phone: 586-256-3725