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General NPI Number Information
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NPI Number | 1902628050
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Entity Type | Organization
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Legal Business Name | ACTIVE DC PHYSIOTHERAPY LLC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 818 18TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20006-3513
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Country | US
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Telephone | 202-780-1663
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Fax |
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Provider Business Mailing Address
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Address Line | 818 18TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20006-3513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HR GENERALIST / CREDENTIALING
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Name | JEWEL MCSWAIN
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Credential |
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Telephone | 415-788-9516
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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 |
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License Number State |
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