Provider Demographics
NPI:1902394612
Name:AKL ACTIVE INC
Entity Type:Organization
Organization Name:AKL ACTIVE INC
Other - Org Name:AKL ACTIVE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:305-290-0622
Mailing Address - Street 1:1712 N RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3409
Mailing Address - Country:US
Mailing Address - Phone:407-272-8813
Mailing Address - Fax:866-802-2363
Practice Address - Street 1:1712 N RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3409
Practice Address - Country:US
Practice Address - Phone:407-272-8813
Practice Address - Fax:866-802-2363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKL ACTIVE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-27
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X
FLOT14170225XP0200X
FL235Z00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024986300Medicaid
FL009550500Medicaid