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General NPI Number Information
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NPI Number | 1073211074
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Entity Type | Organization
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Legal Business Name | ACTIVE REHAB & WELLNESS, LLC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 65 E 73RD AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3655
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Country | US
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Telephone | 219-741-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 7360 E 102ND PL
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City | CROWN POINT
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State | IN
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Zip | 46307-7665
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Country | US
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Telephone | 219-741-2017
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Fax |
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Authorized Official
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Title or Position | MANAGER MEMBER/ OWNER
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Name | YIRIZ PRATO
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Credential | PT, DPT
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Telephone | 219-741-2017
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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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