Provider Demographics
NPI:1013029073
Name:ACTIVE THERAPEUTICS INC
Entity Type:Organization
Organization Name:ACTIVE THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALKIS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ALEXIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-220-5040
Mailing Address - Street 1:6802 MOONLIT DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1630
Mailing Address - Country:US
Mailing Address - Phone:646-220-5040
Mailing Address - Fax:561-204-5928
Practice Address - Street 1:6802 MOONLIT DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1630
Practice Address - Country:US
Practice Address - Phone:646-220-5040
Practice Address - Fax:561-204-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty