MEDICARE: ACTIVE LIFE PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1467228734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE LIFE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	14146 W 119TH ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-6621
Country	:	US
Telephone Number	:	913-232-8864
Fax Number	:	913-308-5347

Provider Business Practice Location Address
First Line	:	14146 W 119TH ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-6621
Country	:	US
Telephone Number	:	913-232-8864
Fax Number	:	913-308-5347

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TROY NELSON SMITH
Credential	:	PT
Telephone Number	:	913-232-8864

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	01/20/2026

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