Provider Demographics
NPI:1063123982
Name:ACTIVATE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ACTIVATE PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-581-5389
Mailing Address - Street 1:19 DARREN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3316
Mailing Address - Country:US
Mailing Address - Phone:732-581-5389
Mailing Address - Fax:
Practice Address - Street 1:19 DARREN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3316
Practice Address - Country:US
Practice Address - Phone:732-581-5389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy