Provider Demographics
NPI:1407072275
Name:ACTIV PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ACTIV PHYSICAL THERAPY, LLC
Other - Org Name:ACTIV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, OCS, COMT
Authorized Official - Phone:330-659-4050
Mailing Address - Street 1:3667 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9667
Mailing Address - Country:US
Mailing Address - Phone:330-659-4050
Mailing Address - Fax:330-659-4052
Practice Address - Street 1:3667 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9667
Practice Address - Country:US
Practice Address - Phone:330-659-4050
Practice Address - Fax:330-659-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-07745261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT-07745OtherOH PT LICENSE- EDWARD J.
OH1356491013OtherNPI-INDIVIDUAL
OH=========-00OtherBWC-GROUP
OH9369371Medicare PIN