Activate Body Potential, Inc.

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

ACTIVATE BODY POTENTIAL, INC.

Practice address

2010 Clipper Park Rd Ste 115
Baltimore, MD 21211-1439

Phone

(410) 235-5220

NPI assigned

Feb 1, 2021

Organization subpart

No

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

Authorized official

Name

Ben James Supik

Title

President / Founder

Phone

(443) 562-7814

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1225629215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 CLIPPER PARK RD STE 115",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111439",
            "telephone_number": "410-235-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 CLIPPER PARK RD STE 115",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111439",
            "telephone_number": "410-235-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVATE BODY POTENTIAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-01",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "SUPIK",
        "authorized_official_first_name": "BEN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT / FOUNDER",
        "authorized_official_telephone_number": "443-562-7814"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.activatebody.com/",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "2010 Clipper Park Rd Ste 115",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212111439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gregory Acree Jr.
• Act Community Services
• Actify ABA Therapy MD, LLC
• Action Behavioral Health LLC
• Action Therapies Inc
• Active 360 Therapy
• Active Day MD, Inc.
• Active Day MD, Inc.
• Active Quality Care Inc
• Actively Aging to Perfection LLC

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; 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.