Active for Life LLC

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

40QA01255300 Issued in NJ

Legal business name

ACTIVE FOR LIFE LLC

Practice address

20 W Spring St
Somerville, NJ 08876-1628

Phone

(908) 303-5846

NPI assigned

May 17, 2018

Last updated

May 17, 2018By 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

Dr. Kerri O'Connor, DPTNPI 1164925475

Title

Doctor

Phone

(908) 303-5846

Specialties & licenses 2

Addresses

Practitioners 1

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.

• Kerri L O'Connor, PT DPT

  • Physical Therapy Clinic/Center
  • Somerville, NJ
  • NPI 1164925475
  NPD (past) Authorized official

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1437649183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 W SPRING ST",
            "city": "SOMERVILLE",
            "state": "NJ",
            "postal_code": "088761628",
            "telephone_number": "908-303-5846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 W SPRING ST",
            "city": "SOMERVILLE",
            "state": "NJ",
            "postal_code": "088761628",
            "telephone_number": "908-303-5846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE FOR LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "KERRI",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "908-303-5846",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NJ",
            "license": "40QA01255300",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "NJ",
            "license": "46TR00658900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Physical Therapist in Somerville, NJ
• Providers in Somerville, NJ by specialty
• Pediatric Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.