Provider Demographics
NPI:1134876329
Name:ACTIVE ORTHOPEDIC HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:ACTIVE ORTHOPEDIC HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWATY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:540-785-8018
Mailing Address - Street 1:4117 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4888
Mailing Address - Country:US
Mailing Address - Phone:540-785-8018
Mailing Address - Fax:
Practice Address - Street 1:4117 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4888
Practice Address - Country:US
Practice Address - Phone:540-785-8018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty