Provider Demographics
NPI:1740692920
Name:KEEP ACTIVE REHAB LLC
Entity type:Organization
Organization Name:KEEP ACTIVE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHRADDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-726-3050
Mailing Address - Street 1:80 CHERRYWOOD DR
Mailing Address - Street 2:NASHUA
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3080
Mailing Address - Country:US
Mailing Address - Phone:978-726-3050
Mailing Address - Fax:
Practice Address - Street 1:80 CHERRYWOOD DR
Practice Address - Street 2:NASHUA
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3080
Practice Address - Country:US
Practice Address - Phone:978-726-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty