Provider Demographics
NPI:1073895884
Name:ACTIVE IN-HOME THERAPY
Entity Type:Organization
Organization Name:ACTIVE IN-HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LEDOUX
Authorized Official - Last Name:HESSION
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-722-2766
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94064-0455
Mailing Address - Country:US
Mailing Address - Phone:650-530-2072
Mailing Address - Fax:650-363-8609
Practice Address - Street 1:1111 CANADA RD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:CA
Practice Address - Zip Code:94062-3508
Practice Address - Country:US
Practice Address - Phone:650-530-2072
Practice Address - Fax:650-851-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy