Provider Demographics
NPI:1023388949
Name:ACTIVECARE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ACTIVECARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EHREN
Authorized Official - Last Name:TROST
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:814-864-4100
Mailing Address - Street 1:3425 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2779
Mailing Address - Country:US
Mailing Address - Phone:814-864-4100
Mailing Address - Fax:814-866-1811
Practice Address - Street 1:3425 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2779
Practice Address - Country:US
Practice Address - Phone:814-864-4100
Practice Address - Fax:814-866-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty