Provider Demographics
NPI:1578880381
Name:BEE ACTIVE, LLC
Entity Type:Organization
Organization Name:BEE ACTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTORATE OF PHYSICAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:865-809-2483
Mailing Address - Street 1:245 PLEASANT POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4477
Mailing Address - Country:US
Mailing Address - Phone:865-809-2483
Mailing Address - Fax:859-268-8507
Practice Address - Street 1:245 PLEASANT POINTE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4477
Practice Address - Country:US
Practice Address - Phone:865-809-2483
Practice Address - Fax:859-268-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT005482225100000X
KY005482252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1245563428OtherINDIVIDUAL NPI