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General NPI Number Information
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NPI Number | 1376416875
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Entity Type | Organization
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Legal Business Name | ACTIVE THERAPY MANAGEMENT LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1905 OLD NACOGDOCHES RD
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City | HENDERSON
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State | TX
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Zip | 75654-4630
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Country | US
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Telephone | 903-657-1563
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 E FRONT ST
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City | TYLER
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State | TX
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Zip | 75702-8511
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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 | ASHOK GUPTA
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Credential | PT
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Telephone | 954-702-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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