Provider Demographics
NPI:1073369849
Name:ACTIVE MOBILE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ACTIVE MOBILE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:MEYER
Authorized Official - Last Name:MERCILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:530-739-3833
Mailing Address - Street 1:3477 FOOTBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2184
Mailing Address - Country:US
Mailing Address - Phone:530-739-3833
Mailing Address - Fax:530-418-0944
Practice Address - Street 1:1242 CENTER ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0617
Practice Address - Country:US
Practice Address - Phone:530-768-8745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy