Provider Demographics
NPI:1316001449
Name:ACTIVE HEALTH AND REHAB
Entity Type:Organization
Organization Name:ACTIVE HEALTH AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:BLONDHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:334-279-5757
Mailing Address - Street 1:3442 EASTDALE CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2163
Mailing Address - Country:US
Mailing Address - Phone:334-279-5757
Mailing Address - Fax:334-279-1257
Practice Address - Street 1:3442 EASTDALE CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2163
Practice Address - Country:US
Practice Address - Phone:334-279-5757
Practice Address - Fax:334-279-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3183261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy