Neuroactive Therapy and Wellness LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

NEUROACTIVE THERAPY AND WELLNESS LLC

Practice address

4500 Cahaba River Blvd
Hoover, AL 35216-6825

Phone

(941) 539-4395

NPI assigned

Jan 3, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Vanessa Rae Kaczmarek, PT, DPT

Title

Owner

Phone

(941) 539-4395

Specialties & licenses 1

Addresses

Other names 1

• NeuroRecovery PT LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

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

{
    "created_epoch": "1704240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706227200000",
    "number": "1760252571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 CAHABA RIVER BLVD",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352166825",
            "telephone_number": "941-539-4395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 CAHABA RIVER BLVD",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352166825",
            "telephone_number": "941-539-4395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROACTIVE THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-03",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A",
        "authorized_official_last_name": "KACZMAREK",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-539-4395",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NeuroRecovery PT LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Physical Therapist in Hoover, AL
• Providers in Hoover, AL by specialty
• Physical Therapist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.