MEDICARE: ACTIVE SOLUTIONS THERAPY SERVICES, INC

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	6802	CO

General Provider Information

NPI Number	:	1497190557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE SOLUTIONS THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 896
Second Line	:
City	:	EDGEWOOD
State	:	NM
Zip	:	87015-0896
Country	:	US
Telephone Number	:	505-286-7838
Fax Number	:	505-286-8025

Provider Business Practice Location Address
First Line	:	716 2ND ST
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1803
Country	:	US
Telephone Number	:	720-685-3141
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. VALERIE GOVE
Credential	:	PT
Telephone Number	:	505-286-7838

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	05/02/2013

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