Provider Demographics
NPI:1558583708
Name:ACTIVE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ACTIVE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAMRIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-351-6048
Mailing Address - Street 1:2424 DANVILLE RD. SW, STE M
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603
Mailing Address - Country:US
Mailing Address - Phone:256-351-6048
Mailing Address - Fax:256-301-8980
Practice Address - Street 1:2424 DANVILLE RD. SW, STE M
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603
Practice Address - Country:US
Practice Address - Phone:256-351-6048
Practice Address - Fax:256-301-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12722261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy