NPIMap

Organization Active NPI

Active Rehab of Michigan

  • Physical Therapist
  • Bad Axe, MI
National Provider Identifier
1235488230
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501005670 Issued in MI
Legal business name
ACTIVE REHAB OF MICHIGAN
Practice address
128 W Huron Ave
Suite B
Bad Axe, MI 48413-1101
Phone
(989) 269-2700
Fax
(989) 269-2705
NPI assigned
Sep 5, 2012
Last updated
Sep 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

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

Authorized official

Name
Eli Kabban
Title
Partner
Phone
(989) 269-2700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501005670 MI Primary

Addresses

Primary practice location

128 W Huron Ave
Suite B
Bad Axe, MI 48413-1101

Mailing address

128 W Huron Ave
Suite B
Bad Axe, MI 48413-1101
Phone (989) 269-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150129000319 MI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 7911152285 Practice locations: Bad Axe, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235488230. Details of each certification follow.

  • CCN 236872 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 236872

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Active Physical Therapy and Sports
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
May 14, 2015
Last certification
May 14, 2015
Ownership / control type
Proprietary
Facility address
128 W Huron Ave, Suite B
Bad Axe, MI 48413

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1235488230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 W HURON AVE",
            "address_2": "SUITE B",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484131101",
            "telephone_number": "989-269-2700",
            "fax_number": "989-269-2705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 W HURON AVE",
            "address_2": "SUITE B",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484131101",
            "telephone_number": "989-269-2700",
            "fax_number": "989-269-2705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE REHAB OF MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-05",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "KABBAN",
        "authorized_official_first_name": "ELI",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "989-269-2700"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501005670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bad Axe, MI

Sources for this page

Verify at the official NPI Registry.