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General NPI Number Information
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NPI Number | 1053364679
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Entity Type | Organization
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Legal Business Name | ACTIVE PHYSICAL THERAPY AND REHAB SERVICES INC.
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 718 HURON AVE
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City | PORT HURON
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State | MI
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Zip | 48060-3704
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Country | US
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Telephone | 810-966-8500
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Fax | 810-966-8600
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Provider Business Mailing Address
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Address Line | 718 HURON AVE
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City | PORT HURON
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State | MI
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Zip | 48060-3704
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Country | US
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Telephone | 810-966-8500
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Fax | 810-966-8600
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. CHAMUNDEESWARI MUTHUVINAYAGAM
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Credential | PHYSICALTHERAPIST
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Telephone | 810-966-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | N/A
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License Number State |
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