NPIMap

Organization Active NPI

Active Life Physical Therapy, LLC

  • Physical Therapist
  • Port Ludlow, WA
National Provider Identifier
1598818262
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00009409 Issued in WA
Legal business name
ACTIVE LIFE PHYSICAL THERAPY, LLC
Practice address
9483 Oak Bay Rd
Port Ludlow, WA 98365-9794
Phone
(360) 437-2444
Fax
(800) 952-8902
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael Andre Haberpointner, M.P.T.NPI 1275686909
Title
Physical Therapist, Director
Phone
(360) 437-2444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00009409 WA Primary

Addresses

Primary practice location

9483 Oak Bay Rd
Port Ludlow, WA 98365-9794

Mailing address

9483 Oak Bay Rd
Port Ludlow, WA 98365-9794
Phone (360) 437-2444

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060504000544 WA Part B Supplier - Clinic/Group Practice 2365452315 Receives reassigned benefits from 4 practitioners
Practice locations: Port Ludlow, WA

National Provider Directory

National Provider Directory

Locations

91 Village Way
Port Ludlow, WA 98365
Phone (360) 437-2444

9483 Oak Bay Rd
Port Ludlow, WA 98365
Phone (360) 437-2444

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598818262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9483 OAK BAY RD",
            "city": "PORT LUDLOW",
            "state": "WA",
            "postal_code": "983659794",
            "telephone_number": "360-437-2444",
            "fax_number": "800-952-8902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9483 OAK BAY RD",
            "city": "PORT LUDLOW",
            "state": "WA",
            "postal_code": "983659794",
            "telephone_number": "360-437-2444",
            "fax_number": "800-952-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HABERPOINTNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANDRE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, DIRECTOR",
        "authorized_official_telephone_number": "360-437-2444",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00009409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Ludlow, WA

Sources for this page

  • 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.