Provider Demographics
NPI:1962653964
Name:ACTIVE DAY
Entity Type:Organization
Organization Name:ACTIVE DAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MOBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-896-1444
Mailing Address - Street 1:3403 BRECKENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3101
Mailing Address - Country:US
Mailing Address - Phone:502-896-1444
Mailing Address - Fax:
Practice Address - Street 1:3403 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3101
Practice Address - Country:US
Practice Address - Phone:502-896-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT001369261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy