Healthcare Provider Details

I. General information

NPI: 1720075880
Provider Name (Legal Business Name): ACTIVE SOLUTIONS THERAPY SERV INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINNIE CT
EDGEWOOD NM
87015-9125
US

IV. Provider business mailing address

PO BOX 896
EDGEWOOD NM
87015-0896
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-7838
  • Fax: 505-286-8025
Mailing address:
  • Phone: 505-286-7838
  • Fax: 505-286-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1666
License Number StateNM

VIII. Authorized Official

Name: MATTHEW SHULTZ
Title or Position: OWNER
Credential: PHD
Phone: 505-286-7838