Activefit Rehab Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT13789 Issued in FL

Legal business name

ACTIVEFIT REHAB PHYSICAL THERAPY LLC

Practice address

4649 Clyde Morris Blvd Unit 607
Port Orange, FL 32129-3003

Phone

(386) 214-2663

NPI assigned

Mar 14, 2017

Last updated

Jun 28, 2017By 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

Ratree Lertkitcharoenpon, PT,DPTNPI 1033650791

Title

President & Coo

Phone

(386) 451-2185

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 4

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.

• Ratree Lertkitcharoenpon, PT,DPT

  • Physical Therapist
  • Port Orange, FL
  • NPI 1033650791
  Medicare reassignment NPD Authorized official
• Philip Cunha, DPT, PT

  • Physical Therapist
  • Port Orange, FL
  • NPI 1528627940
  Medicare reassignment
• Wirat Lertkitcharoenpon, PT,DPT

  • Physical Therapist
  • Port Orange, FL
  • NPI 1811423205
  Medicare reassignment
• Julie Thompson, OTR

  • Physical Rehabilitation Occupational Therapist
  • Ormond Beach, FL
  • NPI 1023294881
  Medicare reassignment

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

{
    "created_epoch": "1489449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498608000000",
    "number": "1114468873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4649 CLYDE MORRIS BLVD UNIT 607",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321293003",
            "telephone_number": "386-214-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4649 CLYDE MORRIS BLVD UNIT 607",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321293003",
            "telephone_number": "386-214-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVEFIT REHAB PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-14",
        "last_updated": "2017-06-28",
        "status": "A",
        "authorized_official_last_name": "LERTKITCHAROENPON",
        "authorized_official_first_name": "RATREE",
        "authorized_official_title_or_position": "PRESIDENT & COO",
        "authorized_official_telephone_number": "386-451-2185",
        "authorized_official_credential": "PT,DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT13789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alaa Abou-Arab
• Adrian Edward Abrahams, D.M.D.
• Anthony Andrew Acabbo, DPT
• Jonathan Xavier Acevedo Nieves
• Cassandre Ackerman, LCSW
• Acubirthing, Inc
• Adam and Or Lori Sainato LLC (Sainato Chiropractic Injury and Wellness Clinic)
• Marijo Danee Adamcik, D.C.
• Candice Adams
• Erica Elizabeth Adams, DC

• Physical Therapy Clinic/Center in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2017; 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.