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General NPI Number Information
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NPI Number | 1013029073
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Entity Type | Organization
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Legal Business Name | ACTIVE THERAPEUTICS INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/02/2007
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Provider Practice Location Address
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Address Line | 6802 MOONLIT DR
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City | DELRAY BEACH
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State | FL
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Zip | 33446-1630
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Country | US
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Telephone | 646-220-5040
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Fax | 561-204-5928
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Provider Business Mailing Address
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Address Line | 6802 MOONLIT DR
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City | DELRAY BEACH
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State | FL
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Zip | 33446-1630
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Country | US
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Telephone | 646-220-5040
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Fax | 561-204-5928
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALKIS ROBERT ALEXIADIS
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Credential | P.T.
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Telephone | 646-220-5040
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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 | 21232
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License Number State | FL
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