=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184592594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROACTIVE PHYSICAL THERAPY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2025
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 275 E. GREEN ST. APT 1441
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-4418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-924-4283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 275 E. GREEN ST. APT 1441
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-4418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-924-4283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANDREW JASON GUTHART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-924-4283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------