Provider Demographics
NPI:1417967944
Name:ACTIVE DEVELOPMENT THERAPIES, LLC
Entity Type:Organization
Organization Name:ACTIVE DEVELOPMENT THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DIRECTOR OF HABILITATION
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLYN
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:LOVING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:281-354-3383
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-0009
Mailing Address - Country:US
Mailing Address - Phone:281-354-3383
Mailing Address - Fax:281-354-6750
Practice Address - Street 1:23750 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-3713
Practice Address - Country:US
Practice Address - Phone:281-354-3383
Practice Address - Fax:281-354-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173277803Medicaid
TX173277801Medicaid
TX173277803Medicaid