Provider Demographics
NPI:1689289324
Name:ACTIVE LIFE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ACTIVE LIFE PHYSICAL THERAPY
Other - Org Name:ACTIVE LIFE REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:197-351-3566
Mailing Address - Street 1:1346 MAIN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2222
Mailing Address - Country:US
Mailing Address - Phone:973-513-5668
Mailing Address - Fax:973-710-3310
Practice Address - Street 1:1346 MAIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2222
Practice Address - Country:US
Practice Address - Phone:973-513-5668
Practice Address - Fax:973-710-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy