Active Solutions Physical Therapy, P.C.
Organization Active NPI Physical Therapy Clinic/Center · Boulder, CO
NPI 1013940808 · NPPES record last updated Jan 3, 2012
Key facts
- NPI
- 1013940808
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- 3897 (CO)
- Legal business name
- ACTIVE SOLUTIONS PHYSICAL THERAPY, P.C.
- Practice address
- 4150 Darley Ave
Suite 8
Boulder, CO 80305-6557 - Phone
- (303) 494-4100
- Fax
- (303) 494-0212
- NPI assigned
- Jul 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Olaf Deroos, PT
- Title
- President
- Phone
- (303) 494-4100
Practitioners 4
-
Chantal Deroos, DPT
-
Olaf Deroos, PT
-
Petra Landfester, P.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040607001507 | CO | Part B Supplier - Clinic/Group Practice | 8224011721 |
Receives reassigned benefits from 3 practitioners Practice locations: Boulder, CO |
National Provider Directory
Locations
4150 Darley Ave
Ste 8
Boulder, CO 80305
Phone (303) 494-4100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | |||
| Physical Therapy Clinic/Center | 261QP2000X | 3897 | CO | Yes |
| Physical Therapy Clinic/Center | 261QP2000X | 3608 | CO |
Addresses
Primary practice location
4150 Darley Ave
Suite 8
Boulder, CO 80305-6557
Mailing address
4150 Darley Ave
Suite 8
Boulder, CO 80305-6557
Phone (303) 494-4100
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.