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General NPI Number Information
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NPI Number | 1073016614
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE PHYSICAL THERAPY & REHAB INC
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 17515 W 9 MILE RD STE 140
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4411
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Country | US
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Telephone | 248-281-4097
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Fax |
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Provider Business Mailing Address
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Address Line | 27320 DEBIASI DR
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City | BROWNSTOWN
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State | MI
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Zip | 48174-8511
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAJ NIJJAR
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Credential |
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Telephone | 734-637-7540
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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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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 5501014085
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License Number State | MI
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