Healthcare Provider Details

I. General information

NPI: 1942114459
Provider Name (Legal Business Name): ACTIVE PHYSIO CARE PT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 MULFORD AVE FL 2
BRONX NY
10461-4009
US

IV. Provider business mailing address

1922 MULFORD AVE FL 2
BRONX NY
10461-4009
US

V. Phone/Fax

Practice location:
  • Phone: 646-784-1736
  • Fax: --
Mailing address:
  • Phone: 646-784-1736
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: CATHRYN MANGUILIN PECSON
Title or Position: OWNER
Credential: PT, DPT, CLT
Phone: 646-784-1736