Proactive Provider Management, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROACTIVE PROVIDER MANAGEMENT, LLC

Doing business as

ProActive Therapeutic Alliance

Practice address

9320 Grand Cordera Pkwy
Ste 125
Colorado Springs, CO 80924-7003

Phone

(719) 535-2757

Fax

(719) 535-2767

NPI assigned

Jan 5, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Scott O'Connor

Title

Member

Phone

(805) 266-4154

Specialties & licenses 6

Addresses

Other names 1

• ProActive Therapeutic Alliance Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1023474152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9320 GRAND CORDERA PKWY",
            "address_2": "STE 125",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809247003",
            "telephone_number": "719-535-2757",
            "fax_number": "719-535-2767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9320 GRAND CORDERA PKWY",
            "address_2": "STE 125",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809247003",
            "telephone_number": "719-535-2757",
            "fax_number": "719-535-2767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE PROVIDER MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-05",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "805-266-4154",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProActive Therapeutic Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.