Provider Demographics
NPI:1073211074
Name:ACTIVE REHAB & WELLNESS, LLC
Entity Type:Organization
Organization Name:ACTIVE REHAB & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YIRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:219-741-2017
Mailing Address - Street 1:7360 E 102ND PL
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7665
Mailing Address - Country:US
Mailing Address - Phone:219-741-2017
Mailing Address - Fax:
Practice Address - Street 1:65 E 73RD AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3655
Practice Address - Country:US
Practice Address - Phone:219-741-2017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty