Provider Demographics
NPI:1033256862
Name:ACTIVE CARE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ACTIVE CARE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:678-787-1436
Mailing Address - Street 1:805 SUWANEE LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3122
Mailing Address - Country:US
Mailing Address - Phone:678-787-1436
Mailing Address - Fax:
Practice Address - Street 1:6342 GRAND HICKORY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-4015
Practice Address - Country:US
Practice Address - Phone:678-787-1436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty