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General NPI Number Information
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NPI Number | 1801841093
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Entity Type | Organization
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Legal Business Name | ACTIVE THERAPY SERVICES INC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 13245 NORTHLINE RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-1070
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Country | US
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Telephone | 734-246-2130
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Fax | 734-246-3545
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Provider Business Mailing Address
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Address Line | 13245 NORTHLINE RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-1070
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Country | US
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Telephone | 734-246-2130
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Fax | 734-246-3545
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Authorized Official
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Title or Position | OWNER
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Name | MR. RAJASINGH JOHNSON
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Credential | PT
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Telephone | 734-246-2130
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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