Active Back Support Services,LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501012727 Issued in MI

Legal business name

ACTIVE BACK SUPPORT SERVICES,LLC

Practice address

9389 Haggerty Rd.
Plymouth, MI 48170

Phone

(734) 582-9770

Fax

(734) 582-9773

NPI assigned

Dec 26, 2006

Organization subpart

No

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

Authorized official

Name

Caroline D Mayer

Title

Office Manager

Phone

(734) 582-9770

Specialties & licenses 1

Addresses

Other names 1

• Active Back Center Doing business as

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124183538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9389 HAGGERTY RD.",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "48170",
            "telephone_number": "734-582-9770",
            "fax_number": "734-582-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9389 HAGGERTY RD.",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "48170",
            "telephone_number": "734-582-9770",
            "fax_number": "734-582-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE BACK SUPPORT SERVICES,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAYER",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "734-582-9770"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501012727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Back Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Plymouth, MI
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.