Provider Demographics
NPI:1720075880
Name:ACTIVE SOLUTIONS THERAPY SERV INC
Entity Type:Organization
Organization Name:ACTIVE SOLUTIONS THERAPY SERV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS COMT FAAOMPT
Authorized Official - Phone:505-286-7838
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-0896
Mailing Address - Country:US
Mailing Address - Phone:505-286-7838
Mailing Address - Fax:505-286-8025
Practice Address - Street 1:1 LINNIE CT
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9125
Practice Address - Country:US
Practice Address - Phone:505-286-7838
Practice Address - Fax:505-286-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM16662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME2935Medicaid
P24929Medicare UPIN
900522210Medicare ID - Type Unspecified