Healthcare Provider Details

I. General information

NPI: 1407072275
Provider Name (Legal Business Name): ACTIV PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3667 BRECKSVILLE RD
RICHFIELD OH
44286-9667
US

IV. Provider business mailing address

3667 BRECKSVILLE RD
RICHFIELD OH
44286-9667
US

V. Phone/Fax

Practice location:
  • Phone: 330-659-4050
  • Fax: 330-659-4052
Mailing address:
  • Phone: 330-659-4050
  • Fax: 330-659-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-07745
License Number StateOH

VIII. Authorized Official

Name: EDWARD JOSEPH ASH
Title or Position: PRESIDENT
Credential: PT, ATC, OCS, COMT
Phone: 330-659-4050