Provider Demographics
NPI:1689353922
Name:PRO-ACTIVE PHYSICAL THERAPY AND DIAGNOSTICS
Entity Type:Organization
Organization Name:PRO-ACTIVE PHYSICAL THERAPY AND DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:T
Authorized Official - Last Name:RHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:894-939-9936
Mailing Address - Street 1:3811 OLD US HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6807
Mailing Address - Country:US
Mailing Address - Phone:989-493-9936
Mailing Address - Fax:
Practice Address - Street 1:3811 OLD US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6807
Practice Address - Country:US
Practice Address - Phone:989-493-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty