Provider Demographics
NPI:1578821302
Name:ACTIVE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ACTIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHRADDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-726-3050
Mailing Address - Street 1:80 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3080
Mailing Address - Country:US
Mailing Address - Phone:978-726-3050
Mailing Address - Fax:866-852-9740
Practice Address - Street 1:681 W HOLLIS ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062
Practice Address - Country:US
Practice Address - Phone:978-726-3050
Practice Address - Fax:866-852-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0014326OtherMEDICARE PTAN