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General NPI Number Information
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NPI Number | 1417967944
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Entity Type | Organization
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Legal Business Name | ACTIVE DEVELOPMENT THERAPIES, LLC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 23435 FM 1314 RD STE C6
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City | PORTER
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State | TX
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Zip | 77365-7738
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Country | US
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Telephone | 281-354-3383
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Fax | 281-354-6750
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | PORTER
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State | TX
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Zip | 77365-0009
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Country | US
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Telephone | 281-354-3383
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Fax | 281-354-6750
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Authorized Official
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Title or Position | PRESIDENT/ DIRECTOR OF HABILITATION
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Name | KIMBERLYN DELANE LOVING
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Credential | PT
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Telephone | 281-354-3383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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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 | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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