Active Life Physical Therapy Center Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

3572 Issued in OR

Legal business name

ACTIVE LIFE PHYSICAL THERAPY CENTER INC

Practice address

616 Hemlock Street
A
Brookings, OR 97415-9412

Phone

(541) 412-1155

NPI assigned

Dec 18, 2006

Last updated

Oct 22, 2007By 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

Mr. Patrick W Dodgen, PT

Title

Physical Therapist

Phone

(541) 412-3717

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1962565291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1628",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974150039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 HEMLOCK STREET",
            "address_2": "A",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159412",
            "telephone_number": "541-412-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE PHYSICAL THERAPY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "DODGEN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "541-412-3717",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": "3572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A M M S Inc (Emerald Anesthesia Service)
• Activating Light Studio LLC
• Kathleen Lynnette Adamson
• Adapt (Adapt Integrated Health Care)
• Adapt
• Adaptive Health Consultants, LLC (Rebecca Meek, WHNP)
• Alder Medical Center PC (Alder Medical Center)

• Physical Therapy Clinic/Center in Brookings, OR
• Providers in Brookings, OR by specialty
• Physical Therapy Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; 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.