Provider Demographics
NPI:1013940808
Name:ACTIVE SOLUTIONS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:ACTIVE SOLUTIONS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAF
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-494-4100
Mailing Address - Street 1:4150 DARLEY AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6557
Mailing Address - Country:US
Mailing Address - Phone:303-494-4100
Mailing Address - Fax:303-494-0212
Practice Address - Street 1:4150 DARLEY AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6557
Practice Address - Country:US
Practice Address - Phone:303-494-4100
Practice Address - Fax:303-494-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
CO3897261QP2000X
CO3608261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO459868Medicare ID - Type Unspecified
CO459858Medicare ID - Type Unspecified
CO=========Medicare UPIN