Provider Demographics
NPI:1366040859
Name:ACTIVE PLUS PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:ACTIVE PLUS PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:734-306-2503
Mailing Address - Street 1:7004 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-2872
Mailing Address - Country:US
Mailing Address - Phone:734-306-2503
Mailing Address - Fax:888-496-5550
Practice Address - Street 1:7004 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2872
Practice Address - Country:US
Practice Address - Phone:734-306-2503
Practice Address - Fax:888-496-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty