Provider Demographics
NPI:1326893074
Name:ACTIVE LIFE PHYSICAL THERAPY AND INJURY CARE
Entity Type:Organization
Organization Name:ACTIVE LIFE PHYSICAL THERAPY AND INJURY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-523-3378
Mailing Address - Street 1:1490 E FOREMASTER DRIVE
Mailing Address - Street 2:STE 260
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-523-3378
Mailing Address - Fax:435-523-3376
Practice Address - Street 1:1490 E FOREMASTER DRIVE
Practice Address - Street 2:STE 260
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-523-3378
Practice Address - Fax:435-523-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty