Provider Demographics
NPI:1851537070
Name:ACTIVE HAND AND PHYSICAL REHABILITATION LP
Entity Type:Organization
Organization Name:ACTIVE HAND AND PHYSICAL REHABILITATION LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF GP
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-572-9000
Mailing Address - Street 1:5120 WOODWAY DR
Mailing Address - Street 2:SUITE 10001
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1723
Mailing Address - Country:US
Mailing Address - Phone:713-572-9000
Mailing Address - Fax:
Practice Address - Street 1:1503 BLUE LAKES BLVD N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3377
Practice Address - Country:US
Practice Address - Phone:208-735-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6201030001Medicare NSC
ID1673696Medicare PIN