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General NPI Number Information
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NPI Number | 1427221910
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Entity Type | Organization
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Legal Business Name | ACTIVE REHABILITATION P.C.
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 129 WAGONWHEEL CT
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City | MARLTON
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State | NJ
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Zip | 08053-4718
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Country | US
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Telephone | 856-596-4347
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Fax | 856-596-6289
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Provider Business Mailing Address
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Address Line | 129 WAGONWHEEL CT
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City | MARLTON
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State | NJ
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Zip | 08053-4718
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Country | US
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Telephone | 856-596-4247
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Fax | 856-596-6289
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | LOIS CORBI
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Credential | PT
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Telephone | 856-596-4247
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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 | 40QA00286500
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License Number State | NJ
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