Provider Demographics
NPI:1972068831
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:OT
Authorized Official - Phone:305-290-0622
Mailing Address - Street 1:11890 SW 8TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1742
Mailing Address - Country:US
Mailing Address - Phone:305-290-0622
Mailing Address - Fax:866-802-2363
Practice Address - Street 1:8351 NW 15TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-4973
Practice Address - Country:US
Practice Address - Phone:305-290-0622
Practice Address - Fax:866-802-2363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKL ACTIVE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-05
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102570100Medicaid