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General NPI Number Information
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NPI Number | 1023728946
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Entity Type | Organization
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Legal Business Name | ACTIV8 PHYSICAL THERAPY AND PERFORMANCE LLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 114 E 2ND ST
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City | ASHLAND
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State | OH
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Zip | 44805-2304
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Country | US
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Telephone | 419-565-8916
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 TOWNSHIP ROAD 1353
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City | ASHLAND
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State | OH
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Zip | 44805-9364
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Country | US
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Telephone | 419-565-8916
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Fax |
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Authorized Official
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Title or Position | CEO PHYSICAL THERAPIST
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Name | MRS. COURTNEY ERIN ALTMAN
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Credential | DPT
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Telephone | 419-565-8916
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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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