Provider Demographics
NPI:1922470640
Name:ACTIVE LIFE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ACTIVE LIFE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-501-0445
Mailing Address - Street 1:7 LITTLETON RD STE G
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3131
Mailing Address - Country:US
Mailing Address - Phone:978-501-0445
Mailing Address - Fax:
Practice Address - Street 1:7 LITTLETON RD STE G
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3131
Practice Address - Country:US
Practice Address - Phone:978-501-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty