MEDICARE: ACTIVA, LC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2251G0304X	Geriatric Physical Therapist
2	2251X0800X	Orthopedic Physical Therapist
3	225200000X	Physical Therapy Assistant
4	225X00000X	Occupational Therapist
5	225XG0600X	Gerontology Occupational Therapist
6	225XL0004X	Low Vision Occupational Therapist
7	225XP0019X	Physical Rehabilitation Occupational Therapist
8	225XP0200X	Pediatric Occupational Therapist
9	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245234848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVA, LC

Provider Business Mailing Address
First Line	:	9720 STIRLING RD
Second Line	:	SUITE 104
City	:	COOPER CITY
State	:	FL
Zip	:	33024-8014
Country	:	US
Telephone Number	:	954-374-0160
Fax Number	:	954-374-0163

Provider Business Practice Location Address
First Line	:	9720 STIRLING RD
Second Line	:	SUITE 104
City	:	COOPER CITY
State	:	FL
Zip	:	33024-8014
Country	:	US
Telephone Number	:	954-374-0160
Fax Number	:	954-374-0163

Authorized Official
Title or Position	:	ADMINISTRATIVE MANAGER
Name	:	MR. OSCAR G. FERREIRA
Credential	:
Telephone Number	:	954-374-0160

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	04/02/2010

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