NPIMap

Organization Active NPI

Active Physical Therapy, LLC

  • Physical Therapist
  • Manasquan, NJ
National Provider Identifier
1982761391
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
QA00936200 Issued in NJ
Legal business name
ACTIVE PHYSICAL THERAPY, LLC
Practice address
2516 Highway 35
Manasquan, NJ 08736-1925
Phone
(732) 223-6309
Fax
(732) 223-6409
NPI assigned
Jan 3, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Travis Spader, MS,PTNPI 1184786618
Title
Director
Phone
(732) 223-6309

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 Therapist 225100000X QA00936200 NJ Primary

Addresses

Primary practice location

2516 Highway 35
Manasquan, NJ 08736-1925

Mailing address

2516 Highway 35
Manasquan, NJ 08736-1925
Phone (732) 223-6309

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111110000172 NJ Part B Supplier - Clinic/Group Practice 8527232412 Receives reassigned benefits from 7 practitioners
Practice locations: Manasquan, NJ; Middletown, NJ

National Provider Directory

National Provider Directory

Locations

2516 Route 35
Manasquan, NJ 08736
Phone (732) 223-0317

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982761391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2516 HIGHWAY 35",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "087361925",
            "telephone_number": "732-223-6309",
            "fax_number": "732-223-6409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 HIGHWAY 35",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "087361925",
            "telephone_number": "732-223-6309",
            "fax_number": "732-223-6409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SPADER",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "732-223-6309",
        "authorized_official_credential": "MS,PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "QA00936200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manasquan, NJ

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.