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General NPI Number Information
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NPI Number | 1407072275
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Entity Type | Organization
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Legal Business Name | ACTIV PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 3667 BRECKSVILLE RD
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City | RICHFIELD
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State | OH
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Zip | 44286-9667
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Country | US
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Telephone | 330-659-4050
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Fax | 330-659-4052
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Provider Business Mailing Address
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Address Line | 3667 BRECKSVILLE RD
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City | RICHFIELD
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State | OH
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Zip | 44286-9667
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Country | US
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Telephone | 330-659-4050
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Fax | 330-659-4052
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD JOSEPH ASH
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Credential | PT, ATC, OCS, COMT
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Telephone | 330-659-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT-07745
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License Number State | OH
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