MEDICARE: ACTIVE REHABILITATION,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		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5109303	OTHER	TX	AETNA,PPO,POS,EPO
2	0002DZ	OTHER	TX	BLUECROSS
3	0078383	OTHER	TX	BLUELINK NUMBER

General Provider Information

NPI Number	:	1629086731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE REHABILITATION,INC.

Provider Business Mailing Address
First Line	:	PO BOX 261441
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75026-1441
Country	:	US
Telephone Number	:	972-964-6633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 COIT RD
Second Line	:	SUITE 101A
City	:	PLANO
State	:	TX
Zip	:	75075-4750
Country	:	US
Telephone Number	:	972-964-6633
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SCOTT CALDWELL
Credential	:	MED.
Telephone Number	:	972-964-6633

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/22/2020

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Directions to “ACTIVE REHABILITATION,INC. ” Practice Location

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