Provider Demographics
NPI:1497190557
Name:ACTIVE SOLUTIONS THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:ACTIVE SOLUTIONS THERAPY SERVICES, INC
Other - Org Name:ADVANCED HEALING PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-286-7838
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-0896
Mailing Address - Country:US
Mailing Address - Phone:505-286-7838
Mailing Address - Fax:505-286-8025
Practice Address - Street 1:716 2ND ST
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1803
Practice Address - Country:US
Practice Address - Phone:720-685-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty