Active Living Rehabilitation Inc
Organization Active NPI Physical Therapist · Trinity, FL
NPI 1437362787 · NPPES record last updated Apr 13, 2010
Key facts
- NPI
- 1437362787
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- ACTIVE LIVING REHABILITATION INC
- Practice address
- 10446 Pontofino Cir
Trinity, FL 34655 - Phone
- (727) 376-4012
- Fax
- (727) 375-7878
- NPI assigned
- May 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Thomas R West
- Title
- Business Manager
- Phone
- (727) 376-4012
Practitioners 9
-
Shelly S West, PHYSICAL THERAPIST
-
Joan T Foster, OTR
-
Stephanie Crawford, M.S.,CCC-SLP
-
Susan Mary Fitzgerald, MA CCCSLP
-
Beverly Wallace, OTR/L
-
Karen Brits, OCCUPATIONAL THERAPI
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031215000756 | FL | Part B Supplier - Clinic/Group Practice | 2365352549 |
Receives reassigned benefits from 4 practitioners Practice locations: Trinity, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X |
Addresses
Primary practice location
10446 Pontofino Cir
Trinity, FL 34655
Mailing address
10446 Pontofino Cir
Trinity, FL 34655-7057
Phone (727) 376-4012
Other providers in Trinity, FL
- A & E of Tampa Bay, LLC
- Muhammad Abdulwhab
- Natalie Abell
- Mazen Abusamaan
- Academic Alliance in Dermatology, Inc
- Dana Adams
- Adelina Liberto, LCSW
- Advanced Integrative Medicine of Tampa Bay LLC
- Advanced Urology Institute LLC
- Sudhir Agarwal
All providers in Trinity, FL · Physical Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.