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General NPI Number Information
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NPI Number | 1578859690
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Entity Type | Organization
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Legal Business Name | ACTIVE PERFORMANCE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 17396 210TH ST
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City | CARROLL
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State | IA
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Zip | 51401-8972
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Country | US
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Telephone | 724-986-0919
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Fax | 724-705-1828
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Provider Business Mailing Address
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Address Line | 17396 210TH ST
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City | CARROLL
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State | IA
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Zip | 51401-8972
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Country | US
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Telephone | 724-986-0919
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Fax | 724-705-1828
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER BRYAN STAUB
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Credential | DPT, MBA
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Telephone | 724-986-0919
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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 | 004651
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License Number State | IA
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