Active Life Spine & Joint Clinic LLC
Organization Active NPI Physical Therapist · Rockford, IL
NPI 1083187553 · NPPES record last updated Jan 8, 2019
Key facts
- NPI
- 1083187553
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- ACTIVE LIFE SPINE & JOINT CLINIC LLC
- Practice address
- 3600 E State St Ste 222
Rockford, IL 61108-1956 - Phone
- (224) 425-0548
- NPI assigned
- Jan 8, 2019
- Organization subpart
- No
Authorized official
- Name
- Ronald Samaniego, PT
- Title
- Owner
- Phone
- (224) 425-0548
National Provider Directory
Locations
3600 E State St
Ste 222
Rockford, IL 61108
Phone (224) 425-0548
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
3600 E State St Ste 222
Rockford, IL 61108-1956
Mailing address
3600 E State St Ste 222
Rockford, IL 61108-1956
Other providers in Rockford, IL
- Stephen Ndede Ackah
- Candice Rose Ackerman
- Eveleen M Ackerman
- Amanda Acosta
- Brooke Acosta
- Carrie Ann Adamany
- Brooke A Adams
- Christina Adams
- Kevin Adams
- Adapt of Illinois, Inc.
All providers in Rockford, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.