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General NPI Number Information
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NPI Number | 1003192121
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Entity Type | Organization
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Legal Business Name | ACTIVE HEALING PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 16902 HIGHLAND AVE BSMT
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City | JAMAICA
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State | NY
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Zip | 11432-2632
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Country | US
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Telephone | 718-844-4832
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Fax | 347-923-3217
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Provider Business Mailing Address
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Address Line | 8450 169TH ST APT 415
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City | JAMAICA
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State | NY
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Zip | 11432-2049
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Country | US
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Telephone | 718-314-6763
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Fax | 347-923-3217
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Authorized Official
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Title or Position | PRESIDENT/ PHYSICAL THERAPY
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Name | DR. IMRUL KABIR
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Credential | DPT
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Telephone | 718-314-6763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 018530
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License Number State | NY
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