Provider Demographics
NPI:1437117934
Name:PRO ACTIVE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:PRO ACTIVE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ROER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-345-7110
Mailing Address - Street 1:29991 FERNHILL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2031
Mailing Address - Country:US
Mailing Address - Phone:248-345-7110
Mailing Address - Fax:248-809-4030
Practice Address - Street 1:29991 FERNHILL DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2031
Practice Address - Country:US
Practice Address - Phone:248-345-7110
Practice Address - Fax:248-809-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P33070Medicare PIN