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General NPI Number Information
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NPI Number | 1003162272
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE THERAPY SERVICES
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 4000 SAWYER RD
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City | SARASOTA
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State | FL
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Zip | 34233-1272
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Country | US
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Telephone | 941-586-7110
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Fax | 941-921-4820
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Provider Business Mailing Address
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Address Line | 8451 WOODBRIAR DR
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City | SARASOTA
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State | FL
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Zip | 34238-5654
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Country | US
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Telephone | 941-586-7110
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Fax | 941-921-4820
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL MAHROUS
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Credential | PT
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Telephone | 941-586-7110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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