Active Life Physical Therapy & Rehab Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5501014085 Issued in MI

Legal business name

ACTIVE LIFE PHYSICAL THERAPY & REHAB INC

Practice address

17515 W 9 Mile Rd Ste 140
Southfield, MI 48075-4411

Phone

(248) 281-4097

NPI assigned

Mar 9, 2018

Last updated

Jan 15, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Raj Nijjar

Title

Ceo

Phone

(734) 637-7540

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Srikrishna Rekulapally, PHYSICAL THRERAPIST

  • Physical Therapist
  • Oak Park, MI
  • NPI 1497120661

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736899200000",
    "number": "1073016614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27320 DEBIASI DR",
            "city": "BROWNSTOWN",
            "state": "MI",
            "postal_code": "481748511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17515 W 9 MILE RD STE 140",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754411",
            "telephone_number": "248-281-4097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27320 DeBiasi Dr",
            "address_purpose": "LOCATION",
            "city": "Brownstown",
            "state": "MI",
            "postal_code": "481748511",
            "country_code": "US",
            "telephone_number": "734-637-7540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ACTIVE LIFE PHYSICAL THERAPY & REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-09",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A",
        "authorized_official_last_name": "NIJJAR",
        "authorized_official_first_name": "RAJ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "734-637-7540"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501014085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyndra Ackerberg
• Catelyn Ackley
• Herik Rodrigo Acosta Gonzalez, M.D.
• Actify Neurotherapies, PLLC
• Active Home Care Inc
• Darius Acuna
• Ada Homes, Inc.
• Sarah R Adair, LMSW
• Ibrahim Adam, LLBSW
• Steven Adamczyk, DO

• Physical Therapy Clinic/Center in Southfield, MI
• Providers in Southfield, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.