Provider Demographics
NPI:1679518328
Name:ACTIVE THERAPY ASSOCIATES INC.
Entity Type:Organization
Organization Name:ACTIVE THERAPY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSEE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:305-883-7859
Mailing Address - Street 1:7911 NW 72ND AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2227
Mailing Address - Country:US
Mailing Address - Phone:305-883-7859
Mailing Address - Fax:305-885-6301
Practice Address - Street 1:7911 NW 72ND AVE
Practice Address - Street 2:STE 204
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2227
Practice Address - Country:US
Practice Address - Phone:305-883-7859
Practice Address - Fax:305-885-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3968Medicare ID - Type UnspecifiedFLORIDA MEDICARE