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General NPI Number Information
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NPI Number | 1225330616
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 5065 HOLLYWOOD BLVD SUITE 201
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City | LOS ANGELES
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State | CA
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Zip | 90027-6122
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Country | US
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Telephone | 323-481-4697
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Fax |
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Provider Business Mailing Address
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Address Line | 5065 HOLLYWOOD BLVD STE 201
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City | LOS ANGELES
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State | CA
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Zip | 90027-6122
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Country | US
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Telephone | 323-665-7675
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN JASON WILKINS
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Credential | DPT
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Telephone | 323-481-4697
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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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