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General NPI Number Information
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NPI Number | 1366040859
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Entity Type | Organization
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Legal Business Name | ACTIVE PLUS PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 01/28/2024
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Provider Practice Location Address
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Address Line | 7004 MICHIGAN AVE
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City | DETROIT
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State | MI
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Zip | 48210-2872
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Country | US
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Telephone | 734-306-2503
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Fax | 888-496-5550
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Provider Business Mailing Address
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Address Line | 7004 MICHIGAN AVE
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City | DETROIT
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State | MI
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Zip | 48210-2872
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Country | US
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Telephone | 734-306-2503
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Fax | 888-496-5550
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Authorized Official
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Title or Position | MANAGER
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Name | KASH NAKUM
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Credential | DPT
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Telephone | 734-306-2503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational 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 | 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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