Provider Demographics
NPI:1265861884
Name:ACTIVE AGING AND REHABILITATION PARTNERS, LLC
Entity Type:Organization
Organization Name:ACTIVE AGING AND REHABILITATION PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:FALVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, GCS, CEEAA
Authorized Official - Phone:207-951-0704
Mailing Address - Street 1:215 WALTERSCHEID BLVD
Mailing Address - Street 2:APT F305
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 WALTERSCHEID BLVD
Practice Address - Street 2:APT F305
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2333
Practice Address - Country:US
Practice Address - Phone:207-951-0704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1376261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy